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What are the characteristic facies in clinical medicine?

Peculiar facies can be seen associated with various disease 

Facies in endocrine disease
  • Acromegalic facies: In acromegaly there is prominent lower jaw, coarse features, large nose, lips, ears, prominent forehead and check bones and widespread teeth
  • Cushing's syndrome patients have rounded 'moon face' with excessive hair growth and facial plethora.
  • Hypothyroid face is characterised by puffy face with a dull expression with swollen eyelids and loss of hair over eyebrows.
  • Hyperthyroid face: In hyperthyroidism patients has anxious look with widely opened eyes with the upper and lower limbus visible this is associated with infrequent blinking and absence of wrinkling of the forehead.
  • Cretinoid face: Face is pale and has a stupid and dull look. Nose is broad and flattened. Lips are thick and separated by a large and fissured protruding tongue. Hair on eyebrows, eyelashes and scalp are very scanty. Prominent medial epicanthal folds and low set ears are noticed
Facies  in autoimmune disease
  • Face in scleroderma: Scleroderma patients has the following characteristic facies.Skin over the face is taut and shiny. Patient finds it difficult to in open his mouth or to smile (microstomia).
  • Face in SLE: SLE is a disease predominantly in women. There is butterfly rash seen over the face affecting the upper cheeks and the nasal bridge.Photosensitivity may be present that is erythema may be seen over the rash on exposure to sunlight.
  • Face in Sjogren's syndrome: There is enlargement of the lacrimal gland on both sides along with enlargement of the parotid and submandibular glands on both sides.
Facies in neurological disease
  • Myasthenic facies: There is bilateral ptosis with outward deviation of the eyes, wrinkling of the forehead and partially opened mouth.
  • Myotonic dystrophy:Is characterised by bilateral ptosis with absence of wrinkling of the forehead, frontal baldness with absent sternomastoids and bilateral cataract.This is characterised by the transverse smile .
  • Parkinsonian face:Patients have immobile, fixed and expressionless face with infrequent blinking of the eyes.Normal rate of eye blinking is about 20 per minute.In Parkinsonism, the rate of blinking is reduced to less than 10 per minute. Blepharoclonus that is on closing the eyes fluttering of the eyelids is seen In postencephalitic parkinsonism, oculogyric crisis is observed.This is characterised by tonic upward deviation or the eyes. A jaw tremor may also be seen.
  • Bell's palsy:There is absence of wrinkling of forehead on the side of the lesion, and the patient is unable to close the eyes, and on attempting to do so the eyeball is seen to move upwards and outwards It is called as Bell'sphenomenon. There is also loss of the nasolabial fold on the side of lesion and deviation of the angle of the mouth to the opposite healthy side on smiling. However in long standing case of Bell's palsy, when contractures of the facial muscles develop,there is prominent nasolabial grooves may be seen on the affected side, creating confusion as to the side of lesion.
Facies in various infections
  • Tabetic facies: Partial ptosis with wrinkling of forehead and unequal.small and irregular pupils.
  • Hippocratic facies-sunken eyes and cheeks,dry lips, looks severely ill.
  • Tetanus-there is characteristic risus sardonicus  blepharospasm and spasm of facial muscle;
  • Leonine facies: Seen in leprosy, there is thickening of the skin and ear lobes with a flattened nasal bridge and there is madarosis rhat is loss of hair over the lateral aspect of eyebrows and eyelashes
Facies in cardiovascular disease
  • Elfin facies: This is seen in supravalvular aortic stenosis, or pulmonary artery stenosis (William's syndrome). There is a presence of a wide mouth with large lips (pouting effect), teeths are widely spaced with broad forehead, pointed chin, protruding ears and hypertelorism(eyes set wide apart).
  • Congenital pulmonary stenosis:Patients have a broad face with eyes set wide apart (moon face).
Facies in respiratory disease
  • Face in pneumonia: In lobar pneumonia, the alae nasi are over active, eyes are bright and shiny.There may be herpes labialis that is herpetic lesions may be present over the angle of the mouth.
  •  Face in COPD: COPD patients have anxious look with bluish discoloration of lips, tip of the nose, ear lobes and breathing out through pursed lips.
Facies in other conditions
  • Cirrhotic facies there is sunken cheeks and eyes with malar prominence and presence ot bilaterally enlarged parotid glands especially in alcoholic cirrhosis 
  • Chip munk facies-characterised by frontomaxillary prominence due to marrow expansion-hemolytic facies in hemolytic anemias
  • Mucopolysaccharidosis (Hurler's)-Patients have coarse features of face, hypertrichosis, large tongue and corneal haziness
  • Face in nephrotic/nephritic syndrome: Face is puffy with periorbital edema and pallor.