From the Research
The pouting sign, also known as the pouting reflex or "Chapeau de gendarme" sign, is localized to the facial muscles, specifically the orbicularis oris muscle, and is characterized by a turned down mouth with contraction of the chin, wrinkling of the lips, and symmetrical lowering of the labial commissures. This sign is most commonly associated with ictal activity, particularly in patients with focal cortical dysplasia, and is often seen in the context of seizures originating from the frontal or temporal lobes 1. The localization of the pouting sign to the facial muscles, particularly the orbicularis oris muscle, is supported by studies on the anatomy and function of the oral commissure and surrounding muscles 2, 3.
When present, the pouting sign may indicate underlying neurological or epileptogenic activity, and its presence should prompt a thorough examination, including video EEG recordings and brain imaging studies, to determine the exact cause of the sign 1. The pouting sign is distinct from other signs or symptoms that may be localized to the hip joint or other areas of the body, and its correct identification and localization are crucial for accurate diagnosis and treatment.
Some studies have reported the use of surgical reconstruction techniques, such as the Estlander flap and upper lip flap techniques, for defects of the lower lip and oral commissure 4, 5. However, these studies are not directly related to the localization or significance of the pouting sign, and should not be considered in the context of this sign.
In clinical practice, the presence of a pouting sign should prompt a thorough neurological examination, including assessment of seizure activity and focal neurological deficits, as well as imaging studies to rule out underlying structural or functional abnormalities 1. The correct localization and identification of the pouting sign are essential for accurate diagnosis and treatment, and can help clinicians focus their examination and diagnostic efforts on the relevant areas of the body.