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Logo of archdischfnArchives of Disease in Childhood - Fetal & NeonatalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child Fetal Neonatal Ed. 2007 September; 92(5): F385.
PMCID: PMC2675364

Asymmetrical crying facies in monozygotic twins

We present a case of 4‐day‐old monozygotic twin girls with asymmetrical crying facies. Asymmetrical crying facies is caused by unilateral hypoplasia or aplasia of the depressor anguli oris muscle. The essential clinical finding is failure of one corner of the mouth to move downwards and outwards during crying or grimacing (fig 11).). There is no asymmetry when the baby is awake but quiet. Other functions of the facial muscles, such as frowning and closing the eyes, and the depth of the nasolabial fold, are normal. This helps to distinguish the disorder from peripheral facial palsy. The cause of the defect is unknown. The present case of monozygotic twins indicates a possible genetic origin. Although asymmetrical crying facies is an isolated benign finding in most cases, it can be associated with cardiovascular, musculoskeletal, respiratory, central nervous system, genitourinary and chromosomal anomalies.

figure fn117549.f1
Figure 1 Four‐day‐old monozygotic twin girls with the characteristic presentation of congenital asymmetrical crying facies. Parental/guardian informed consent was obtained for publication of this figure.


Competing interests: None.

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