Congenital Unilateral Hypoplasia of the Orbicularis Oris Muscle: A Rare Cause of Congenital Unilateral Upper Lip Palsy

doi:10.4236/mps.2013.32012

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Modern Plastic Surgery, 2013, 3, 65-67

http://dx.doi.org/10.4236/mps.2013.32012 Published Online April 2013 (http://www.scirp.org/journal/mps)

Congenital Unilateral Hypoplasia of the Orbicularis

Oris Muscle: A Rare Cause of Congenital Unilateral

Upper Lip Palsy

Sadık Şentürk1, Duran Efe2

1Department of Plastic and Reconstructive Surgery, Mevlana (Rumi) University Hospital, Konya, Turkey; 2Department of Radiology,

Mevlana (Rumi) University Hospital, Konya, Turkey.

Email: [email protected], [email protected]

Received January 14th, 2013; revised February 20th, 2013; accepted February 28th, 2013

cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Asymmetric facial appearance may originate from abnormalities of facial musculature or facial innervation. Congenital

absence or hypoplasia of facial muscles has not been known except for the depressor anguli oris muscle. Even,

congenital unilateral hypoplasia of the orbicularis oris muscle cause of unilateral upper lip palsy has not been reported

in the literature up to day. In this report, we present a patient with congenital unilateral upper lip palsy although the

facial nerve was normal.

Keywords: Congenital Upper Lip Palsy; Unilateral Hypoplasia; Orbicularis Oris Muscle

1. Introduction

Asymmetric facial appearance may occur abnormalities

of facial musculature or facial innervation. Asymmetric

face is occur in 0.2% - 0.6% of newborns [1-3]. Con-

genital absence or hypoplasia of facial muscles is un-

common anomaly causing a remarkable aesthetic de-

formity. Congenital absence or hypoplasia of facial mus-

cles has not been known except for the depressor anguli

oris muscle. Even, congenital unilateral hypoplasia of the

orbicularis oris muscle cause of unilateral upper lip palsy

has not been reported in the literature up to day. In this

report, we present a patient with congenital unilateral

upper lip palsy although the facial nerve was normal.

Clinical presentation of patients with asymmetric face is

characterized by the lip appears distorted towards the

healthy side. Diagnosis can be detectable by the clinical

picture, an electromyographic and magnetic resonance

imaging study [4,5].

2. Case Report

A 33-year-old girl presented with asymmetric movement

of upper lip when she whistled and ate. The patient de-

nied having any previous trauma, major infection, or

facial surgery and was unaware of any other associated

congenital deformity. Her medical history was otherwise

unremarkable. The patient was born at term after an un-

eventful pregnancy. Physical examination revealed thin

unilateral upper lip. The face appeared symmetric at rest

(Figure 1). The patient had inward deviation of right

upper lip when she whistled (Figure 2). Facial nerve

function, as determined by frowning/forehead, wrinkling,

eye closure, nasolabial fold depth, and tearing, was sym-

metric. Neurologic exam was normal. Magnetic reso-

nance imaging of the upper lip were unilateral hypoplasia

of the orbicularis oris muscle (Figure 3).

3. Discussion

Asymmetric facial appearance may occur abnormalities

of facial musculature or facial innervation. Asymmetric

face is occur in 0.2% - 0.6% of newborns [1-3]. Con-

genital absence or hypoplasia of facial muscles is un-

common anomaly causing a remarkable aesthetic defor-

mity. Congenital absence or hypoplasia of facial muscles

has not been known except for the depressor anguli oris

muscle. Even, congenital unilateral hypoplasia of the

orbicularis oris muscle has not been reported in the lit-

erature up to day. Clinical presentation of patients with

congenital unilateral hypoplasia of the orbicularis oris

includes typical clinical picture, which includes upper lip

asymmetry during whistling while forehead wrinkling,

Congenital Unilateral Hypoplasia of the Orbicularis Oris Muscle:

A Rare Cause of Congenital Unilateral Upper Lip Palsy

Figure 1. Patient with right-sided asymmetric upper lip at

rest.

Figure 2. The upper lip is pulled toward the intact left side.

Figure 3. Magnetic resonance imaging of the upper lip were

unilateral hypoplasia of the orbicularis oris muscle.

nasolabial fold depth, and eye closure remain intact and

equal on both side. Diagnosis can be detectable by the

clinical picture, an electromyographic and magnetic re-

sonance imaging study [4,5]. Differential diagnosis of

upper lip asymmetry includes facial nerve paralysis and

trauma factors. Facial nerve lesions may cause weakness

of facial expressions; however, congenital unilateral hy-

poplasia of the orbicularis oris afflicts upper lip while

other functions of facial nerves are preserved.

Congenital palsy of the depressor anguli oris muscle,

said to have an asymmetric crying facies is characterized

by facial asymmetry that is usually first noticed when the

infant cries, because half of the lower lip manifests a

pulled-down, outward appearance. It is also known as

congenital unilateral lower lip palsy, congenital hypo-

plasia of the depressor anguli oris muscle, and partial

facial paralysis [6-8]. A wide variety of anomalies in-

volving cardiovascular, gastrointestinal, genitourinary,

skeletal, and central nervous systems may be seen in

children with congenital hypoplasia of depressor anguli

oris [9-13].

The pathogenesis of congenital absence or hypoplasia

of facial muscles has not been established. Up to day,

intrauterine molding, viral infection during pregnancy,

and heredity have been suggested as causative factor

[14,15]. Nonetheless, pathogenesis of congenital absence

or hypoplasia of facial muscles appears to be multifactor-

rial and further studies are needed to elucidate it.

As a result, the present case highlights the clinical

presentation of congenital unilateral hypoplasia of the

orbicularis oris muscle that causes asymmetric face.

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