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Photographic smile tracking: Evidence of asymmetric crying faces over time improvement: Case report
Maamouri Sabrine1, Marouen Ben Rejeb1, Karima Zitouni1
1Department of Oral, Maxillofacial and Cosmetic Surgery, University Hospital of Charles Nicolle, 1006, Tunis, Tunisia.
Insights
Congenital hypoplasia of the depressor anguli oris muscle causes unilateral lower lip asymmetry. A 10-year-old boy showed improvement with a "wait and see" approach and photographic tracking.
Area of Science:
- Pediatric Neurology
- Craniofacial Anomalies
- Congenital Disorders
Background:
- Congenital hypoplasia of the depressor anguli oris muscle (CDAOM) presents as facial asymmetry, often mistaken for other conditions.
- This rare disorder is characterized by unilateral weakness of the lower lip, noticeable during emotional expressions like crying or smiling.
Observation:
- A 10-year-old boy presented with a congenital, unilateral inability to depress the right lower lip, evident when opening his mouth.
- Initial examination revealed no asymmetry at rest, but a distinct deficit in lower lip depression on the right side.
- Extensive investigations including CT, MRI, EMG, and echocardiography showed no associated abnormalities.
Findings:
- The case highlights a rare presentation of congenital hypoplasia of the depressor anguli oris muscle without other congenital anomalies.
- Photographic smile tracking demonstrated natural improvement in the asymmetric crying face over time.
- A conservative 'wait and see' strategy proved effective for this patient.
Implications:
- This case underscores the importance of accurate diagnosis for congenital lower lip asymmetry.
- It suggests that a conservative management approach may be sufficient for isolated CDAOM, reassuring families.
- Further research into the natural history and optimal management of CDAOM is warranted.
Introduction:
Congenital hypoplasia of the depressor anguli oris muscle is a rare mimic disorder depicted by a lower lip asymmetry apparent when laughing or crying.
Presentation Of Case:
A 10-year-old boy consulted our department for an asymmetry when opening his mouth. According to the family, this asymmetry was present since birth. Perinatal characteristics and childhood medical history were investigated with no abnormalities. Physical exam revealed an inability to draw down the right lower lip unilaterally. At rest position, facial asymmetry was not noticeable. Several investigations were done: A CT scan of the petrous part of the temporal bone, an MRI of soft tissues, an electromyography and a heart ultrasound. No anomalies were found.
Discussion:
This condition has stimulated great interest because of its potential association with congenital anomalies but also in order to reassure families often worried by the situation. A large therapeutic armamentarium is described in literature.
Conclusion:
Among the large armamentarium of therapeutic options, we opted for a wait and see strategy through photographic smile tracking leading to an evidence of Asymmetric crying faces over time improvement.
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