Please click to enlarge.
Note what signs you see.
I (W. Wertelecki, M.D.) see facial asymmetry in a child with other signs of NF1.
PERSPECTIVE: Any degree of facial asymmetry in the context of NF1 is a very important signal of probably a emerging plexiform neurofibroma. Such “tumors” are aggressive, hypervascular and generally rapidly growing. On palpation their temperature is higher than surrounding regions suggestive of an active vascular neogenesis.
Shown in the center are patches of hyperpigmentation. Such patches in preferential locations (periocular, preauricular, lateral neck, periaxillary, feet, etc) should be viewed as a prodrom of a plexiform neurofibroma (see NF1 tutorial). Also note the growth of hypopigmented hair on the hyperpigmented patch – the clinical record indicates that on palpation the patch is warmer than the same contralateral region.
The third image of an unrelated patient underscores the presence of agressive plexiform neurofibrome in the same region (please see other images of this second patient).