Asymmetric crying facies and associated congenital anomalies: Prospective study and review of the literature

Congenital asymmetric crying facies, a minor congenital anomaly due to abse nce or hypoplasia of the depressor anguli oris muscle on one side of the mo uth, is associated at times with major congenital anomalies, most commonly in the cardiovascular system. In a prospective study of 5532 infants born a t the Assaf Harofeh Medical Center, Israel, during 12 months (January to De cember 1998), 17 infants (an incidence of 0.31%) had asymmetric crying faci es. One of the affected infants had ventricular septal defect and another i nfant had VATER (vertebral defects, imperforate anus, tracheoesophageal fis tula, and radial and renal dysplasia) syndrome. No noxious obstetric perina tal factors could be identified. Family history was unremarkable in all cas es. Diagnostic work-up performed in all of the affected infants failed to r eveal an additional congenital malformation. Asymmetric crying facies is a minor isolated finding in most of the cases; however, a thorough search for other congenital malformations, especially of the cardiovascular system, s hould be performed.