CASE REPORT A 38-year-old male patient presented with severe asymmetrical lower lip deformity during full mouth opening since birth (Fig. 1A). He presented mild asymmetry of corners during mouth closing (Fig. 1B). [ncbi.nlm.nih.gov]

The child presented with asymmetric movement of lower lip since birth. Asymmetry of lower lip was more pronounced when she smiled and cried. Rest of the face movement was symmetric. On examination, the face appeared symmetric at rest. [pubmed.ncbi.nlm.nih.gov]

• Crying

  […] of one corner of the mouth during crying) while eye closure, nasolabial fold and forehead wrinkling are symmetric. [ebi.ac.uk]

  Congenital hypoplasia of depressor anguli oris is a rare anomaly that causes asymmetric crying face. [pubmed.ncbi.nlm.nih.gov]

  Asymmetric crying facies with microcephaly and mental retardation: an autosomal dominant syndrome with variable expressivity. Clin Genet. 1986;30:481–4. [PubMed] [Google Scholar] 15. Renault F. [ncbi.nlm.nih.gov]

• Weakness

  Congenital heart disease and facial weakness, a hitherto unrecognized association. Archives of Disease in Childhood. 1969;44(233):69–75. - PMC - PubMed LinkOut - more resources Full Text Sources Europe PubMed Central Hindawi Limited PubMed Central [pubmed.ncbi.nlm.nih.gov]

  Parmelee [1] first described facial weakness apparent during crying. Cayler [2] reported the cases of five patients with both congenital partial lower facial paresis involving unilateral lower lip depressors and heart defects. [ncbi.nlm.nih.gov]

• Heart Disease

  Congenital heart disease and facial weakness, a hitherto unrecognized association. Archives of Disease in Childhood. 1969;44(233):69–75. - PMC - PubMed LinkOut - more resources Full Text Sources Europe PubMed Central Hindawi Limited PubMed Central [pubmed.ncbi.nlm.nih.gov]

  An “epidemic” of congenital facial paresis and heart disease. Pediatrics. 1967;40:666–8. [PubMed] [Google Scholar] 3. Sapin SO, Miller AA, Bass HN. Neonatal asymmetric crying facies: a new look at an old problem. Clin Pediatr (Phila) 2005;44:109–19. [ncbi.nlm.nih.gov]

• Suggestibility

  Therefore, they suggested that newborns with ACF should be referred for further screening for 22q11.2 deletion syndrome. [ncbi.nlm.nih.gov]

• Neglect

  Microsurgical strategies in 74 patients for restoration of dynamic depressor muscle mechanism: a neglected target in facial reanimation. Plast Reconstr Surg. 2000;105:1917–31. [PubMed] [Google Scholar] 18. Yavuzer R, Jackson IT. [ncbi.nlm.nih.gov]

• Paresis

  Cayler [2] reported the cases of five patients with both congenital partial lower facial paresis involving unilateral lower lip depressors and heart defects. Neonatal ACF is estimated to occur in 0.6% of infants. [ncbi.nlm.nih.gov]

• Excitement

  The conduction times and results of nerve excitability studies were normal and confirmed the intactness of the facial nerves. EMG showed signs of hypoplasia of the DAO muscle in 41 of 51 infants with ACF. [ncbi.nlm.nih.gov]

DLI muscle resection is a simple and effective procedure for the treatment of marginal mandibular nerve palsy. The results are permanent and predictable. [ncbi.nlm.nih.gov]

Spontaneous recovery is expected with the former but not necessarily with the latter etiology [3]. The diagnosis can be established by the clinical features and/or electromyography (EMG) [4]. [ncbi.nlm.nih.gov]