Case 3: Newborn with Asymmetric Crying Face

Presentation

A 35-week-gestation male infant is delivered by cesarean section in the setting of maternal premature rupture of membrane and fetal nonreassuring heart tracing during the process of labor induction. The mother is a 30-year-old, gravida 2, para 1, healthy woman without significant medical history. Maternal antenatal testing results are normal with unremarkable prenatal complications. The neonate is the product of a nonconsanguineous marriage. At birth, the infant’s head is delivered without instrumental assistance or birth trauma. He is vigorous and cries immediately after birth. Resuscitation efforts include a brief period of continuous positive airway pressure and oxygen support for increased work of breathing and desaturation; however, the infant recovers quickly and is transferred to the sick newborn unit in room air. His Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Physical examination reveals a nondistressed premature infant with normal vital parameters. His birthweight, length, and occipitofrontal circumference are 1,840 g, 39 cm, and 31.5 cm, respectively. He is found to have an asymmetric crying face. When he is quiet or sleeping, his face appears symmetric. However, when he cries, the left corner of the mouth is drawn to the left and downward while the right corner does not move. The forehead wrinkling, nasolabial fold depth, and eye closure remain intact and equal on both sides (Fig 1). All extraocular muscle movements are intact. He has an overfolded helix with squared superior portion of helix of bilateral ears and microretrognathia (Fig 2). Other physical examination findings are unremarkable. There is no history of a similar condition on both sides of the family.