Adriana Ferreira, Inês Paiva Ferreira, Eulália Sousa, Cláudia Monteiro
Pediatrics Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
Address for Correspondence: Adriana Ferreira, Avenida do Hospital Padre Américo 210, 4564-007 Guilhufe.
Email: adriana.amf1@gmail.com
Keywords : Congenital, Facial asymmetry, Infant
Question: A seven-month-old male infant presented to the emergency department with mild respiratory symptoms. During the observation, asymmetry of the face with a downward deviation of the right labial commissure was noted when the patient was crying (Figure 1). At rest, the face was symmetric except for a slightly thinner and inward-turned lower left lip (Figure 2). According to the parents, these alterations have been present since the first days of life. The further neurologic assessment was normal. No other major or minor malformations were detected and cardiac auscultation was normal without murmurs. He presented normal growth and neurodevelopment. There was no history of problems with sucking or drooling and no family history of congenital abnormalities, including facial asymmetry. The patient was a second-born child from nonconsanguineous parents. Pregnancy was uneventful and the patient was born at 38-3/7 weeks gestation by cesarean section because of prolonged labor, with a birth weight of 3270 g, birth length of 51 cm and head circumference of 35 cm. Apgar scores at 1, 5 and 10 minutes were 7, 8 and 10, respectively.
Figure 1. Facial asymmetry observed when crying with the right side of the mouth deviated downward while the left side remained unmoved.
Figure 2. Symmetrical facial expression at rest with only the left lower lip slightly thinner and turned inwards.
