What is Moebius syndrome?

From the Guidelines

Moebius syndrome is a rare neurological disorder characterized by facial paralysis and limited eye movement from birth, primarily affecting the ability to move the eyes side-to-side and causing facial weakness or paralysis. The primary features of Moebius syndrome include:

• Inability to move the eyes side-to-side
• Facial weakness or paralysis, causing a "mask-like" appearance
• Difficulty swallowing and speaking As seen in a recent case study published in 2024 in the journal Ophthalmology 1, a 21-month-old with Moebius syndrome presented with parental concern of increased right eye rubbing, highlighting the importance of ocular surveillance in these patients. Treatment for Moebius syndrome focuses on managing symptoms, including:

1. Physical therapy to improve muscle strength and coordination
2. Speech therapy to aid communication and swallowing
3. Occupational therapy for daily living skills
4. Surgical procedures to improve facial appearance and function For infants, special feeding techniques or tubes may be necessary, as noted in the case study where a therapeutic penetrating keratoplasty was performed 1. As children grow, they may need educational support and assistive devices. The exact cause of Moebius syndrome is unknown but likely involves abnormal development of cranial nerves during pregnancy, and early diagnosis and multidisciplinary care are crucial for optimal outcomes, as emphasized by the need for examination under anesthesia and intraoperative OCT in the recent case study 1. Genetic counseling may be recommended for families planning future pregnancies. While challenging, many individuals with Moebius syndrome lead fulfilling lives with appropriate support and interventions, and recent studies such as the one published in Ophthalmology in 2024 1 continue to shed light on the complexities of this condition.

From the Research

Definition and Characteristics of Moebius Syndrome

• Moebius syndrome is a rare congenital disorder characterized by bilateral or unilateral paralysis of the facial and abducens nerves 2, 3, 4, 5, 6
• The paralysis of the VI and VII cranial nerves leads to a lack of function in the muscles they supply, resulting in facial paralysis and difficulty with eye movement 2, 3, 4, 5, 6

Associated Symptoms and Complications

• Facial paralysis often causes bilabial incompetence with speech difficulties, oral incompetence, problems with eating and drinking, including pocketing of food in the cheek and dribbling, as well as severe drooling 2
• Involvement of other cranial nerves, such as the V, X, XI, and XII cranial nerves, can result in difficulty with chewing, swallowing, and coughing, leading to respiratory complications 4
• Mental retardation and autism have been reported in some cases 4
• Limb malformations, skeletal malformations, and orofacial anomalies may also be associated with the disorder 4, 5

Diagnosis and Treatment

• Early recognition of Moebius syndrome can lead to early diagnosis and treatment, and education of healthcare professionals is crucial for this purpose 3
• Surgical reconstruction, such as microsurgical reconstruction and free-muscle transplantation, can be used to restore facial movement and improve functional outcomes 2
• Special considerations must be taken during anesthesia and dental management for patients with Moebius syndrome, especially those with associated mental retardation and behavioral problems 4