Figure 171.1.— Facial molding. The right jaw appears sharper while the left is fuller. The facial asymmetry is present during [A] crying and [B] quiet awake.
Figure 171.2— Asymmetrical face due to plagiocephaly. The asymmetry is present while asleep [A], awake [B], and when crying [C].
Unilateral lambdoid suture or coronal suture (Figure 171.3) synostoses is a frequent cause of facial asymmetry.
Figure 171.3— Right coronal suture synostosis. [A] Deviation of the sagittal suture and abnormal shape of the anterior fontanel; the orbits are of different sizes. [B] Coronal suture synostosis. [C] Normal coronal suture.
Plagiocephaly may be isolated or part of a syndrome (Figure 171.4). Plagiocephaly should be corrected surgically by 4 to 6 months of age.
Figure 171.4— Asymmetrical face due right coronal suture synostosis in patient with Apert syndrome. The asymmetry is present while awake [A], and when crying [B]. Bony and cutaneous syndactyly [C].
Bone and cutaneous syndactyly is very severe in neonates with Apert syndrome. (Figure 171.5).
Figure 171.1.— Bony and cutaneous syndactyly involving both hands in patient with Apert syndrome.
Figure 171.5— Facial hemangioma. The facial asymmetry is less apparent during [A] quiet awake than when [B] crying.
Figure 171.6.— Large neck lymphangioma producing facial asymmetry.