Facial Molding
Facial molding is a musculoskeletal deformation (Figure 171.1). It is usually due to compression of the face against the walls of the uterus or the neonate’s own shoulder. Although the area involved by the asymmetry may vary, the jaw is the area most often involved. In most cases the deformity is usually not noticeable by one year of age.Marked malocclusion of the alveolar process may occur with severe jaw deformities. Treatment is usually not needed except in most severe cases.

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.

Plagiocephaly
Plagiocephaly or asymmetrical craniosynostosis may produce an asymmetrical face (Figure 171.2).

A	B	C

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.

A	B	C

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.

A	B	C

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.

Facial Tumors
Facial tumors in the neonate are rare. The distribution of the asymmetry is related to the location and size of the tumor. In most cases there is an obvious mass. The asymmetry may change with action but it will never disappear (Figure 171.5).

Figure 171.5— Facial hemangioma. The facial asymmetry is less apparent during [A] quiet awake than when [B] crying.

The most frequent tumors in the facial region are teratomas, adenocarcinomas, and carcinomas arising in the area of the parotid and salivary glands. Lymphangiomas (cystic hygromas) of the neck may grow large enough to produce facial distortion (Figure 171.6). Facial tumors usually require surgery.

Figure 171.6.— Large neck lymphangioma producing facial asymmetry.