Facial asymmetry in crying newborn.

To cite: Magalhães M, Costa D, Brites A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015211212 DESCRIPTION A 6-day-old newborn girl from an unremarkable pregnancy and vaginal delivery was observed for the first time by her primary care physician presenting facial asymmetry when crying. Physical and neurological examination showed facial asymmetry noted only on crying, with a drooping of the right corner of the mouth (figure 1). The eyelid closure, nasolabial fold depths, forehead elevation and tearing, were symmetric and normal. The facial asymmetry disappeared after the crying stopped (figure 2) and, according to the mother, this was happening since birth. Asymmetric crying facies (ACF) is characterised by lower lip asymmetry in neonates only during crying. ACF has an incidence of 1:160 live births. It can result from a developmental abnormality caused by absence (agenesis) or incomplete development (hypoplasia) of the depressor muscle of the angle of the mouth or of the depressor muscle of the lower lip; likewise, it can result from a traumatic compression of the facial nerve in utero or during labour. 2 ACF, considered a minor anomaly, however, causes severe parental distress. If misdiagnosed it