Nelson KB, Eng GD. Congenital hypoplasia of the depressor anguli oris muscle: differentiation from congenital facial palsy. J Pediatr 1972; 81:16-20. Pape KE, Pickering D. Asymmetric crying facies: an index of other congenital anomalies. J Pediatr 1972; 81:21-30. The term asymmetric crying facies was first used by Pape and Pickering to describe episodes of facial asymmetry appreciated only when an infant is crying. They proposed that this finding resulted from partial paralysis of the contralateral seventh nerve and reported an association with other major anomalies in multiple systems, particularly cardiac anomalies, which had previously been linked to asymmetric crying facies as the “cardiofacial syndrome” by Cayler in 1967. Fifty years ago, the incidence, etiology, and significance of asymmetric crying facies were still under debate. In fact, Pape and Pickering's article was coupled in that same volume of The Journal with an article by Nelson and Eng describing the same clinical entity. However, in that report, this clinical finding was found to be due to the congenital hypoplasia of the depressor anguli oris muscle; the authors stated that this minor anomaly was benign and unrelated to other congenital anomalies. A better understanding of etiology and incidence has since been described, with current consensus maintaining the etiology of asymmetric crying facies as hypoplasia of the depressor anguli oris muscle. The current incidence of asymmetric crying facies is approximately 0.6% and, although a minor isolated finding in most cases, a wide range of major malformations involving all systems, particularly cardiac, have been reported in infants with asymmetric crying facies, with the incidence ranging from 5% to 20%.1Sapin S.O. Miller A.A. Bass H.N. Neonatal asymmetric crying facies: a new look at an old problem.Clin Pediatr (Phila). 2005; 44: 109-119Crossref PubMed Scopus (30) Google Scholar Associations between asymmetric crying facies and chromosome 22q11.2 microdeletions also have been reported.2Innes A.M. Asymmetric crying facies and associated congenital anomalies: the contribution of 22q11.2 microdeletions.J Child Neurol. 2001; 16: 778Crossref PubMed Scopus (10) Google Scholar Currently, there are no clear consensus management guidelines for asymmetric crying facies. Given the associations with chromosome 22q11.2 microdeletions and major congenital anomalies, it is not unreasonable to consider further investigation with fluorescence in situ hybridization analysis and screening for anomalies (particularly cardiac). We would recommend these be based on clinical judgement and physical examination, including careful auscultation of the heart.