Congenital asymmetrical crying facies

Congenital asymmetrical crying facies, a minor congenital anomaly due to hypoplasia or the absence of the depressor muscle of the angle of the mouth (musculus depressor anguli oris), manifests as lower lip asymmetry during crying. In a prospective study of 1,600 neonates born at the J.L.N. Medical College in Ajmer, India, during the period from January 1979 to August 1979, 10 infants (6.3 per 1,000 infants) had asymmetrical crying facies. Two of the 10 affected neonates had congenital heart disease (1 ventricular septal defect; 1 tetralogy of Fallot), compared with three out of 1,590 members of a control group (p < 0.001). Five babies had other minor congenital malformations. Four of the 10 mothers of probands and three of twelve siblings had the same anomaly, suggesting a familial etiologic factor. No noxious obstetric or prenatal factor could be identified. At a follow-up examination (3 to 6 months later), all of the infants showed normal growth and development, although the effects of the anomaly persisted. We suggest that asymmetrical crying facies is a commonly occurring minor congenital malformation, and in its presence, a thorough search for other congenital malformations, especially of the cardiovascular system, should be made.