Symptom Finder - Abnormal Facies
FACIES, ABNORMAL
A list of possible causes of abnormal facies can best be arrived at by thinking of the endocrine, cardiovascular, nervous, and skeletal systems.
Endocrine system: This would bring to mind the coarse facial features of myxedema and cretinism, the proptosis of hyperthyroidism, the moon face of Cushing syndrome, and the square protruding jaw of acromegaly. It would also suggest the Peter Pan face of
hypopituitarism.
Cardiovascular system: This should prompt the recall of the malar flush in mitral stenosis and the cyanosis of congenital heart disease. Facial edema is seen in superior vena cava syndrome and nephritis.
Nervous system: This should suggest the masked face of Parkinsonism, the hatchet-shaped face of myotonic dystrophy, the snarl of myasthenia gravis, and the drawing of the face to one side in Bell palsy with flattening of the nasolabial fold. It should also suggest the expressionless face and often drooling mouth of bulbar and pseudobulbar palsy and sarcastic smile of patients with tetanus.
Skeletal system: This would bring to mind the protruding forehead of Paget disease and the wide separation of the eyes in hypertelorism.
Aside from these disorders it is well to recall the flushing of the face in alcoholism, Cushing syndrome, carcinoid syndrome, and menopause as well as the waxy non wrinkled face of scleroderma and the oriental appearance of the face in mongolism.
Approach to the Diagnosis
Obviously, the workup of abnormal facies will depend on what disease is suggested by the facial appearance combined with other abnormalities of the physical and neurologic examination. A careful history will be helpful in many cases.
A list of possible causes of abnormal facies can best be arrived at by thinking of the endocrine, cardiovascular, nervous, and skeletal systems.
Endocrine system: This would bring to mind the coarse facial features of myxedema and cretinism, the proptosis of hyperthyroidism, the moon face of Cushing syndrome, and the square protruding jaw of acromegaly. It would also suggest the Peter Pan face of
hypopituitarism.
Cardiovascular system: This should prompt the recall of the malar flush in mitral stenosis and the cyanosis of congenital heart disease. Facial edema is seen in superior vena cava syndrome and nephritis.
Nervous system: This should suggest the masked face of Parkinsonism, the hatchet-shaped face of myotonic dystrophy, the snarl of myasthenia gravis, and the drawing of the face to one side in Bell palsy with flattening of the nasolabial fold. It should also suggest the expressionless face and often drooling mouth of bulbar and pseudobulbar palsy and sarcastic smile of patients with tetanus.
Skeletal system: This would bring to mind the protruding forehead of Paget disease and the wide separation of the eyes in hypertelorism.
Aside from these disorders it is well to recall the flushing of the face in alcoholism, Cushing syndrome, carcinoid syndrome, and menopause as well as the waxy non wrinkled face of scleroderma and the oriental appearance of the face in mongolism.
Approach to the Diagnosis
Obviously, the workup of abnormal facies will depend on what disease is suggested by the facial appearance combined with other abnormalities of the physical and neurologic examination. A careful history will be helpful in many cases.
