Some facial characteristics are so typical of certain diseases that they immediat ely suggest the diagnosis.
These are pathognomic to certain disease and are call ed diagnostic facies. Some of the important diagnostic facies are: From left to right: 1. Acromegaic facies 2. Adenoid facies 3. Amiodarone facies 4. Bell's palsy 5. Bird facies 6. Asymmetric crying facies 7. Bovine facies 8. C hipmunk facies 9. Cushingoid facies 10. Elfin facies 11. Gargoyle facies 12. Leo nine facies 13. MEN-2B Syndrome 14. Parkinsonian facies 15. Flat facies 16. Mitr al facies 17. Hatchet facies 18. Snarling facies 19. Thyrotoxic facies 20. Myxed ematous facies Acromegalic facies (Acromegaly) Large supraorbital ridge and frontal bossing, thickened lips, enlarge tongue , lower jaw firm and square (protruding jaw = prognathism) Adenoid facies (Adenoid hypertrophy) Long, open-mouthed, dumb-looking face of children Amiodarone facies Deep blue discoloration around malar area and nose Bells palsy (Facial nerve dysfunction) The eyelids on the paralyzed side cant close. The mouth is drawn to the unpar alyzed side, producing a somewhat grotesque appearance. Food and drink dribble f rom the mouth on the paralyzed side. The eye with the involved lid dries due to decreased tear production. Bird facies (Pierre Robin Malformation) Small lower jaw, a slit like hole in the palate of mouth (called cleft palat e) and the tongue appear to fall into the throat (condition called as retrogloss optosis) Assymeteric crying facies (Cayler cardiofacial syndrome) Asymmetric appearance of the oral aperture and lips at rest, but significant depression of one side of the lower lip with animation (crying or smiling) Bovine facies (Craniofacial Dysostosis or Crouzon syndrome) Convex nasal profile, shortened mandible, macroglossia Chipmunk facies (B-Thalassemia major, Bullimia nervosa, Parotid swelling) Expanded globular maxillae, with BM hyperexpansion into facial bones, combin ed with prominent epicanthal folds Cushingoid facies (Cushing syndrome) A rounded face with a double chin, prominent flushed cheeks, and fat deposit s in the temporal fossa and cheeks Elfin facies (Williams Syndrome)
Sunken nasal bridge, puffiness around eyes, epicanthal fold, blue starry eye s, long upper lip length, small and widely spaced teeth, small chin Gargoyle facies (Hurler syndrome) Head is large and dolichocephalic, with frontal bossing and prominent sagitt al and metopic sutures, with mid-face hypoplasia, depressed nasal bridge, flared nares, and a prominent lower 13 of face, thickened facies, widely spaced teeth a nd attenuated dental enamel, gingival hyperplasia Leonine facies (Lepromatous Leprosy) Peculiar, deeply furrowed, lionlike appearance of the face MEN 2B Syndrome Usually there are numerous yellowish-white, sessile, painless nodules on the lips or tongue, with deeper lesions having normal coloration. There may be enou gh neuromas in the body of the lips to produce enlargement and a blubbery lip appe arance. Similar nodules may be seen on the sclera and eyelids. Parkinsonian facies (Parkinsonism) Mask-like, tremor of head, absence of blinking, dribbling of saliva, weaknes s of upward gaze, seborrhoea and sweatiness Flat facies (Down syndrome) Flat appearing face, small head, flat bridge of the nose, smaller than norma l, low-set nose, small mouth which causes the tongue to stick out and to appear overly large, upward slanting eyes, epicanthal fold, rounded cheeks, small missh apen ears Mitral facies (Mitral stenosis) Rosy, flushed cheeks and dilated capillaries Myotonic or Hatchet facies (Myotonic dystrophy) Tented, open mouth, elongated face and blunt affect Snarling or Myasthenic facies (Myasthenia gravis) Drooping of the eyelids and corners of the mouth and weakness of the facial muscles Thyrotoxic facies (Graves disease) Alert, startled, flushed and anxious appearance. Protrusion of of one or bot h eyes (exopthamlos) associated with retraction of the upper eyelids (lid lag) w hich results in the exposure of white conjunctiva above the cornea (Von-Graefs si gn) Torpid or Myxedematous (Myxedema) Skin generally thickened, alopecia, periorbital oedema, xanthelasma, coolnes s and dryness of skin and hair, thinning of scalp hair, tongue swelling. Others:
Ashen gray facies (Myocardial infarction) Cockayne facies (Cockayne syndrome) Frog like facies (Intranasal disease) Hepatic facies (Chronic liver disease) Hippocratic or Cachectic facies (close to death after severe and prolonged i llness like Malignancy) Marshall halls facies (Hydrocephalus) Monkey facies (Marasmus) Mouse facies (Chronic renal failure) Pagetic facies (Pagets disease) Ricketic facies (Rickets) Uremic facies (Uremia)
