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Asymmetric Crying Facies with Multiple Congenital Malformations: a Case Report.

SYMMETRIC crying facies (ACF) is characterized by facial asymmetry only when crying. It may present as an exclusive symptom, or be concomitant with other congenital malformations and even some fatal birth defects. Clinically, ACF is featured by drooping of the intact corner of the mouth during crying, while the face appears symmetric at rest. The facial nerve function is symmetric, as determined by frowning, forehead wrinkling, eye closure, and nasolabial fold depth. When ACF alone is present, the cause is often compression of the mandibular branch of the facial nerve that is probably due to birth trauma or abnormal fetal posture in utero. ACF with other congenital anomalies is usually caused by hypoplasia of the depressor anguli oris muscle (DAOM) on one side of the mouth. We described a 26-month-old girl with ACF and multiple congenital malformations in this report and reviewed the relevant literature regarding the occurrence, coexisting anomalies, probable etiologies, and surgical intervention. It is suggested that ACF can be an indicator of coexisting anomalies, and a comprehensive examination should be conducted in these patients.