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Facial grimacing

MedGen UID:
65891
Concept ID:
C0234853
Finding; Finding
Synonym: Facial grimace
SNOMED CT: Facial grimacing (37126005)
 
HPO: HP:0000273

Definition

Facial grimacing is characterized by a distorted, distressed look. The brow is more wrinkled, as is the area around the mouth. Eyes may be squeezed shut. [from LNC]

Term Hierarchy

Conditions with this feature

5p partial monosomy syndrome
MedGen UID:
41345
Concept ID:
C0010314
Disease or Syndrome
Cri-du-chat syndrome was first described by Lejeune et al. (1963) as a hereditary congenital syndrome associated with deletion of part of the short arm of chromosome 5. The deletions can vary in size from extremely small and involving only band 5p15.2 to the entire short arm. Although the majority of deletions arise as new mutations, approximately 12% result from unbalanced segregation of translocations or recombination involving a pericentric inversion in one of the parents.
Pigmentary pallidal degeneration
MedGen UID:
6708
Concept ID:
C0018523
Disease or Syndrome
Pantothenate kinase-associated neurodegeneration (PKAN) is a type of neurodegeneration with brain iron accumulation (NBIA). The phenotypic spectrum of PKAN includes classic PKAN and atypical PKAN. Classic PKAN is characterized by early-childhood onset of progressive dystonia, dysarthria, rigidity, and choreoathetosis. Pigmentary retinal degeneration is common. Atypical PKAN is characterized by later onset (age >10 years), prominent speech defects, psychiatric disturbances, and more gradual progression of disease.
Striatonigral degeneration, infantile, mitochondrial
MedGen UID:
374113
Concept ID:
C1839022
Disease or Syndrome
Urofacial syndrome 2
MedGen UID:
767434
Concept ID:
C3554520
Disease or Syndrome
Urofacial syndrome (UFS) is characterized by prenatal or infantile onset of urinary bladder voiding dysfunction, abnormal facial movement with expression (resulting from abnormal co-contraction of the corners of the mouth and eyes), and often bowel dysfunction (constipation and/or encopresis). Bladder voiding dysfunction increases the risk for urinary incontinence, megacystis, vesicoureteric reflux, hydroureteronephrosis, urosepsis, and progressive renal impairment. In rare instances, an individual who has (a) a molecularly confirmed diagnosis and/or (b) an affected relative meeting clinical diagnostic criteria manifests only the characteristic facial features or only the urinary bladder voiding dysfunction (not both). Nocturnal lagophthalmos (incomplete closing of the eyes during sleep) appears to be a common and significant finding.
Paroxysmal nonkinesigenic dyskinesia 1
MedGen UID:
1631383
Concept ID:
C4551506
Disease or Syndrome
Familial paroxysmal nonkinesigenic dyskinesia (PNKD) is characterized by unilateral or bilateral involuntary movements. Attacks are typically precipitated by coffee, tea, or alcohol; they can also be triggered by excitement, stress, or fatigue, or can be spontaneous. Attacks involve dystonic posturing with choreic and ballistic movements, may be accompanied by a preceding aura, occur while the individual is awake, and are not associated with seizures. Attacks last minutes to hours and rarely occur more than once per day. Attack frequency, duration, severity, and combinations of symptoms vary within and among families. Age of onset is typically in childhood or early teens but can be as late as age 50 years.
Rubinstein-Taybi syndrome due to CREBBP mutations
MedGen UID:
1639327
Concept ID:
C4551859
Disease or Syndrome
Rubinstein-Taybi syndrome (RSTS) is characterized by distinctive facial features, broad and often angulated thumbs and halluces, short stature, and moderate-to-severe intellectual disability. The characteristic craniofacial features are downslanted palpebral fissures, low-hanging columella, high palate, grimacing smile, and talon cusps. Prenatal growth is often normal, then height, weight, and head circumference percentiles rapidly drop in the first few months of life. Short stature is typical in adulthood. Obesity may develop in childhood or adolescence. Average IQ ranges between 35 and 50; however, developmental outcome varies considerably. Some individuals with EP300-RSTS have normal intellect. Additional features include ocular abnormalities, hearing loss, respiratory difficulties, congenital heart defects, renal abnormalities, cryptorchidism, feeding problems, recurrent infections, and severe constipation.
Intellectual developmental disorder with paroxysmal dyskinesia or seizures
MedGen UID:
1727046
Concept ID:
C5436894
Disease or Syndrome
Intellectual developmental disorder with paroxysmal dyskinesia or seizures (IDDPADS) is an autosomal recessive complex neurologic disorder characterized by global developmental delay with impaired intellectual development and language delay. In addition, most patients develop a paroxysmal hyperkinetic movement disorder in the first months or years of life manifest as sudden falls or backward propulsion, eye or head deviation, and dystonic limb posturing followed by chorea and dyskinetic movements. The episodes are pharmacoresistant to anticonvulsant medication. EEG may show interictal abnormalities, but are usually not consistent with epilepsy. However, some patients may also develop epileptic seizures or only have seizures without a movement disorder (summary by Doummar et al., 2020).

Professional guidelines

PubMed

Menlah A, OseiAppiah E, Garti I, Frempomaa Agyare D
J Perioper Pract 2023 Jul-Aug;33(7-8):223-232. Epub 2021 Dec 29 doi: 10.1177/17504589211064039. PMID: 34963377
Ruda JM, Krakovitz P, Rose AS
Otolaryngol Clin North Am 2012 Jun;45(3):653-69, viii. doi: 10.1016/j.otc.2012.03.005. PMID: 22588042
Naylor WP, Douglass CW, Mix E
Oral Surg Oral Med Oral Pathol 1984 May;57(5):508-11. doi: 10.1016/0030-4220(84)90309-8. PMID: 6587299

Recent clinical studies

Etiology

Salman AE, Salman MA, Saricaoglu F, Akinci SB, Aypar Ü
J Clin Anesth 2011 Jun;23(4):270-4. doi: 10.1016/j.jclinane.2010.09.008. PMID: 21663809
Igier V, Mullet E, Sorum PC
Eur J Pain 2007 Jul;11(5):542-50. Epub 2006 Sep 7 doi: 10.1016/j.ejpain.2006.07.003. PMID: 16962342
Danek A, Tison F, Rubio J, Oechsner M, Kalckreuth W, Monaco AP
Mov Disord 2001 Sep;16(5):882-9. doi: 10.1002/mds.1188. PMID: 11746618
Donat JF, Wright FS
J Child Neurol 1991 Oct;6(4):313-8. doi: 10.1177/088307389100600405. PMID: 1940132
Naylor WP, Douglass CW, Mix E
Oral Surg Oral Med Oral Pathol 1984 May;57(5):508-11. doi: 10.1016/0030-4220(84)90309-8. PMID: 6587299

Diagnosis

Ruda JM, Krakovitz P, Rose AS
Otolaryngol Clin North Am 2012 Jun;45(3):653-69, viii. doi: 10.1016/j.otc.2012.03.005. PMID: 22588042
Wright B, Beverley D
Clin Child Psychol Psychiatry 2012 Apr;17(2):221-8. Epub 2011 Jul 6 doi: 10.1177/1359104511403680. PMID: 21733931
Igier V, Mullet E, Sorum PC
Eur J Pain 2007 Jul;11(5):542-50. Epub 2006 Sep 7 doi: 10.1016/j.ejpain.2006.07.003. PMID: 16962342
Danek A, Tison F, Rubio J, Oechsner M, Kalckreuth W, Monaco AP
Mov Disord 2001 Sep;16(5):882-9. doi: 10.1002/mds.1188. PMID: 11746618
Donat JF, Wright FS
J Child Neurol 1991 Oct;6(4):313-8. doi: 10.1177/088307389100600405. PMID: 1940132

Therapy

Becerra L, Aasted CM, Boas DA, George E, Yücel MA, Kussman BD, Kelsey P, Borsook D
Pain 2016 Apr;157(4):840-848. doi: 10.1097/j.pain.0000000000000446. PMID: 26645550Free PMC Article
Salman AE, Salman MA, Saricaoglu F, Akinci SB, Aypar Ü
J Clin Anesth 2011 Jun;23(4):270-4. doi: 10.1016/j.jclinane.2010.09.008. PMID: 21663809
Hirota N, Hirota M, Mezaki T
Parkinsonism Relat Disord 2008 Nov;14(7):579-80. Epub 2008 Mar 3 doi: 10.1016/j.parkreldis.2007.12.001. PMID: 18316230
Mahurkar SD, Meyers L Jr, Cohen J, Kamath RV, Dunea G
Kidney Int 1978 Apr;13(4):306-15. doi: 10.1038/ki.1978.44. PMID: 651129
Tarsy D, Granacher R, Bralower M
Am J Psychiatry 1977 Sep;134(9):1032-4. doi: 10.1176/ajp.134.9.1032. PMID: 409302

Prognosis

Garcia-Minaur S, Oliver F, Yanez JM, Soriano JR, Quinn F, Reardon W
Clin Dysmorphol 2001 Jul;10(3):165-70. doi: 10.1097/00019605-200107000-00002. PMID: 11446407
Tan A, Salgado M, Fahn S
Mov Disord 1997 Jan;12(1):47-52. doi: 10.1002/mds.870120109. PMID: 8990053
Finucane BM, Konar D, Haas-Givler B, Kurtz MB, Scott CI Jr
Dev Med Child Neurol 1994 Jan;36(1):78-83. doi: 10.1111/j.1469-8749.1994.tb11770.x. PMID: 8132119
Donat JF, Wright FS
J Child Neurol 1991 Oct;6(4):313-8. doi: 10.1177/088307389100600405. PMID: 1940132
Donovan MK, Lenn NJ
Pediatr Neurol 1989 Sep-Oct;5(5):311-3. doi: 10.1016/0887-8994(89)90024-6. PMID: 2803390

Clinical prediction guides

Becerra L, Aasted CM, Boas DA, George E, Yücel MA, Kussman BD, Kelsey P, Borsook D
Pain 2016 Apr;157(4):840-848. doi: 10.1097/j.pain.0000000000000446. PMID: 26645550Free PMC Article
Sukhudyan BG, Dimova PS, Capuano A, Vigevano F
Epileptic Disord 2014 Mar;16(1):5-12. doi: 10.1684/epd.2014.0628. PMID: 24556527
Igier V, Mullet E, Sorum PC
Eur J Pain 2007 Jul;11(5):542-50. Epub 2006 Sep 7 doi: 10.1016/j.ejpain.2006.07.003. PMID: 16962342
Cantrell FL, Ritter M, Himes E
J Emerg Med 2004 Oct;27(3):271-2. doi: 10.1016/j.jemermed.2004.06.003. PMID: 15388215
Ipp M, Taddio A, Goldbach M, Ben David S, Stevens B, Koren G
Can J Clin Pharmacol 2004 Spring;11(1):e2-7. Epub 2004 Apr 1 PMID: 15226521

Recent systematic reviews

Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G
Pediatrics 1998 Feb;101(2):E1. doi: 10.1542/peds.101.2.e1. PMID: 9445511

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