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Duggal I, Zere E, Kumar Chaudhari P, Duggal R, Singh Rana S, Chauhan A. The challenging management of Moebius syndrome using orthodontic camouflage: A case report. SPECIAL CARE IN DENTISTRY 2024; 44:450-457. [PMID: 37287118 DOI: 10.1111/scd.12888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
Moebius syndrome (MS) is a rare congenital neuromuscular disorder characterized by weakness or paralysis (palsy) of abducens and facial nerves, or other cranial nerves which may be affected. Diagnosis, treatment, and dental management of MS patients are focused on treating manifestations like malocclusion, while catering to associated extraoral (neurologic, dermatologic, ocular) complications, aiming to improve their quality of life. Here, we report the case of a 9-year-old female patient with MS who underwent orthodontic camouflage using combined orthopedic-orthodontic therapy using a high-pull chin cup and fixed orthodontic appliance to improve skeletal mal-relation and facial appearance. The outcome displayed great improvement in function and better esthetics, improving not only the patient's but also the family's quality of life. A year's follow-up showed successful maintenance of the achieved results. A multidisciplinary approach in MS not only helps in overcoming the treatment challenges but also provides great psychosocial benefits to these patients.
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Affiliation(s)
- Isha Duggal
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Edlira Zere
- Orthodontic and Craniofacial Department, School of Graduate Dentistry, Rambam Health, Care Campus, Technion, Faculty of Medicine, Haifa, Israel
| | - Prabhat Kumar Chaudhari
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anuj Chauhan
- Department of Medical Health and Family Welfare, Uttar Pradesh, India
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2
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Alarcón-Sánchez MA, Romero-Servin S, Yessayan L, Mosaddad SA, Heboyan A. Oral findings and comprehensive dental management of Moebius syndrome: a systematic review. BMC Oral Health 2024; 24:192. [PMID: 38321523 PMCID: PMC10845393 DOI: 10.1186/s12903-024-03968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/01/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Moebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral and extraoral findings in MS patients and their comprehensive dental management. METHODS A digital search was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, restricted to articles in English from Jan 01, 2000, to Apr 02, 2023, following PRISMA guidelines. The methodological quality of the studies was evaluated following the JBI guidelines. Qualitative analysis was carried out on the overall result, extraoral and intraoral manifestations, considering dental management as appropriate. RESULTS Twenty-three studies were included, and a total of 124 cases of patients with MS were analyzed. The 82% of patients with MS were younger than 15 years of age. The most frequent extraoral manifestations were blinking and visual problems (78,22%), malformations of the upper and lower limbs (58,22%), bilateral facial paralysis (12,90%), lack of facial expression (12.09%), and unilateral facial paralysis (6,45%). On the other hand, the most frequent oral manifestations were tongue deformities (78,22%), micrognathia (37,90%), labial incompetence (36,29%), cleft palate (22,87%), gothic palate (16,12%), microstomia (15,32%), anterior open bite (15,32%), dental caries (8,87%), and periodontal disease (8,06%). The majority of MS patients were treated by pediatric dentistry (60,86%), using a surgical approach (56,52%), and orthodontic and orthopedic maxillary (43,47%) followed by restorative (39,13%), and periodontal treatments (21,73%). CONCLUSIONS This systematic review demonstrates that patients with MS present a wide variety of oral and extraoral manifestations, for which dental treatments are planned and tailored to each patient in accordance with oral manifestations. These treatments encompass problem resolution and oral health maintenance, incorporating recent techniques in managing and treating patients with MS.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Science, Autonomous University of Guerrero, Chilpancingo 39090, Guerrero, Mexico
| | - Selenne Romero-Servin
- Resident Student, Oral and Maxillofacial Pathology, National School of Higher Studies, Leon Unit of the National Autonomous University of Mexico, Leon 37684, Guanajuato, Mexico
| | - Lazar Yessayan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-e-Dasht Street, Shiraz, Iran.
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
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Havner C, Roussakis AÖ, Sjögreen L, Westerlund A. Open Bite Malocclusion and Orofacial Dysfunction in Patients with Myotonic Dystrophy Type 1 and Duchenne Muscular Dystrophy. J Neuromuscul Dis 2023; 10:885-896. [PMID: 37334614 PMCID: PMC10578289 DOI: 10.3233/jnd-230025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
Open bite (OB) is a common malocclusion in individuals with orofacial dysfunction and syndromes, especially in neuromuscular diseases. OBJECTIVES The objectives were to explore the prevalence of OB in myotonic dystrophy type 1 (DM1) and Duchenne muscular dystrophy (DMD) and to create and compare orofacial dysfunction profiles. METHODS In this database study, 143 individuals with DM1 and 99 with DMD were included. The Mun-H-Center questionnaire and observation chart were used together with the Nordic Orofacial Test -Screening (NOT-S) to create orofacial dysfunction profiles. OB was categorised as: lateral (LOB); anterior (AOB); severe anterior (AOBS); or both types of anterior OB (AOBTot). Descriptive and multivariate statistics were used to compare the OB prevalence and to study associations with orofacial variables, respectively. RESULTS There was a statistically significant difference in OB prevalence between the DM1 (37%) and DMD (49%) groups (p = 0.048). LOB was seen in < 1% of DM1 and 18% of DMD. LOB was associated with macroglossia and closed mouth posture, AOB with hypotonic lips, and open mouth posture and AOBS with hypotonic jaw muscles. The orofacial dysfunction profiles showed similar patterns, although the mean NOT-S total scores for DM1 and DMD were 4.2±2.8 (median 4.0, min-max 1-8) and 2.3±2.0 (median 2.0, min-max 0-8), respectively. LIMITATIONS The two groups were not age- or gender-matched. CONCLUSION OB malocclusion is common in patients with DM1 and DMD and is associated with different types of orofacial dysfunction. This study highlights the need for multi-disciplinary assessments to support tailored treatment strategies that improve or sustain orofacial functions.
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Affiliation(s)
- Christina Havner
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Anna Ödman Roussakis
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Lotta Sjögreen
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Westerlund
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gheorghe DC, Stanciu AE, Zamfir‐Chiru‐Anton A, Doru O, Epure V. Moebius syndrome-Case report. Clin Case Rep 2022; 10:e6715. [PMID: 36523389 PMCID: PMC9748237 DOI: 10.1002/ccr3.6715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Moebius Syndrome is a rare multifactorial condition defined by congenital complete or partial VII and VIth cranial nerves palsy and other physical abnormalities. We present the case of a 3 months old infant with Moebius sequence and breathing and eating difficulties, managed by tracheostomy and laryngoplasty.
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Affiliation(s)
- Dan Cristian Gheorghe
- Carol DavilaUniversity of Medicine and PharmacyBucharestRomania
- ENT Department“MS Curie” HospitalBucharestRomania
| | - Adina E. Stanciu
- Institute of Oncology BucharestDepartment of Carcinogenesis and Molecular BiologyBucharestRomania
| | | | - Oprea Doru
- ENT Department“MS Curie” HospitalBucharestRomania
| | - Veronica Epure
- Carol DavilaUniversity of Medicine and PharmacyBucharestRomania
- ENT Department“MS Curie” HospitalBucharestRomania
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A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies. Neural Plast 2021; 2021:8890541. [PMID: 33833792 PMCID: PMC8016575 DOI: 10.1155/2021/8890541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.
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Pamplona MDC, Ysunza PA, Telich-Tarriba J, Chávez-Serna E, Villate-Escobar P, Sterling M, Cardenas-Mejia A. Diagnosis and treatment of speech disorders in children with Moebius syndrome. Int J Pediatr Otorhinolaryngol 2020; 138:110316. [PMID: 32829202 DOI: 10.1016/j.ijporl.2020.110316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Moebius syndrome (MS) is characterized by congenital bilateral paralysis of the facial and abducens nerves. Clinical features include feeding problems, dysarthria, dysphagia, sialorrhea, strabismus, and lack of facial expression. Patients with MS frequently present with dysphagia during infancy. Further on during childhood a severe speech disorder is a common feature. However, articulation deficits in patients with MS are scarcely reported in the related scientific literature. OBJECTIVE The aim of this study is to describe speech deviations, intelligibility and sialorrhea in patients with MS. MATERIAL AND METHODS Eighty-seven patients with MS were prospectively studied. Age ranged from 4 to 18 years. A complete Speech and Language Pathology (SLP) evaluation was performed in all cases. The evaluation focused on articulation placement, sialorrhea and intelligibility of speech. RESULTS Sialorrhea was detected in 23% of the patients. Abnormal articulation placement of bilabial phonemes was observed in 68% of the patients. Another 50% of the patients presented with articulation placement errors in other phonemes. Intelligibility was classified as adequate in 18% of the cases. Mildly affected intelligibility was found in 51% of the patients. Speech was considered moderately unintelligible in 20% of the cases. Unintelligible speech was found in 11% of the patients. CONCLUSIONS From the results of this prospective study it can be concluded that a high percentage of patients with MS are at high risk of presenting with moderate to severe speech disorders. Thus, an early SLP intervention should be provided for this population in order to enhance speech development and reducing the risk of severe oral communication impairments.
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Affiliation(s)
- Maria Del Carmen Pamplona
- Plastic and Reconstructive Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico; Hablarte e Integrarte AC, Mexico City, Mexico.
| | | | - Jose Telich-Tarriba
- Plastic and Reconstructive Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
| | - Enrique Chávez-Serna
- Plastic and Reconstructive Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
| | - Pamela Villate-Escobar
- Plastic and Reconstructive Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
| | - Mariana Sterling
- Plastic and Reconstructive Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
| | - Alexander Cardenas-Mejia
- Plastic and Reconstructive Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
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7
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Sugiyama AI, Shiota S, Yamada T, Ito J, Suzuki K, Takahashi K. Sleep-related breathing disorders associated with the characteristics of underlying congenital rare diseases of Moebius syndrome and Poland syndrome. Respirol Case Rep 2020; 8:e00579. [PMID: 32435499 PMCID: PMC7235444 DOI: 10.1002/rcr2.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022] Open
Abstract
A 24-year-old woman was referred to us with daytime sleepiness. She has two congenital intractable and rare diseases, namely, Moebius syndrome and Poland syndrome. Physiological examinations and a detailed usage analysis under a ventilation device helped to conclude that hypoglossal nerve paralysis and thoracic deformity from her two underlying diseases were associated closely with her final diagnosis of obstructive sleep apnoea and sleep-related hypoventilation due to medical disorders. Bilevel positive pressure ventilation with auto-titrating expiratory positive airway pressure was effective. This is the first report that describes in detail the causal interactions between underlying two intractable and rare diseases and sleep-related breathing disorders.
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Affiliation(s)
- Ai Inagaki Sugiyama
- Division of Respiratory MedicineJuntendo University Faculty of Medicine & Graduate School of MedicineTokyoJapan
| | - Satomi Shiota
- Division of Respiratory MedicineJuntendo University Faculty of Medicine & Graduate School of MedicineTokyoJapan
| | - Tomoko Yamada
- Division of Respiratory MedicineJuntendo University Faculty of Medicine & Graduate School of MedicineTokyoJapan
| | - Jun Ito
- Division of Respiratory MedicineJuntendo University Faculty of Medicine & Graduate School of MedicineTokyoJapan
| | - Kazuhiro Suzuki
- Division of RadiologyJuntendo University Faculty of Medicine & Graduate School of MedicineTokyoJapan
| | - Kazuhisa Takahashi
- Division of Respiratory MedicineJuntendo University Faculty of Medicine & Graduate School of MedicineTokyoJapan
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8
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Renault F, Flores-Guevara R, Baudon JJ, Sergent B, Charpillet V, Denoyelle F, Thierry B, Amiel J, Gitiaux C, Vazquez MP. Orofacial motor dysfunction in Moebius syndrome. Dev Med Child Neurol 2020; 62:521-527. [PMID: 31713842 DOI: 10.1111/dmcn.14379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2019] [Indexed: 12/13/2022]
Abstract
AIM To review orofacial disabilities and their consequences in children with Moebius syndrome (MBS). METHOD We retrospectively analysed the records of 32 patients (21 males, 11 females) with non-progressive bilateral facial and abducens palsies who had been examined before 6 months of age. RESULTS All facial muscles were severely involved in 17 patients; in the 15 others, partial movements were found in the lower face. Most patients (n=24) were unable to smile. Patients frequently presented with congenital trismus (n=20) and drooling (n=18). Additional palsies involved cranial nerves IX and X (n=18) and XII (n=25). Sucking was absent or weak in 30 patients; swallowing was impaired in 25. During the first month of life, feeding disorders were graded as severe/moderate in 25. Respiratory complications occurred in 17. Severe feeding disorders were associated with congenital trismus (p=0.01) and with cranial nerve IX and X palsy (p=0.01). Growth failure between 1 and 6 months of age, followed by catch-up growth between 6 and 12 months, was observed in 20 patients. Between 2 and 5 years of age, 25 out of 32 patients attained normal oral diet and 28 out of 29 showed normal growth. INTERPRETATION Children with MBS frequently require adjusted therapeutic options to prevent failure to thrive. Congenital trismus, cranial nerve IX and X palsy, and laryngeal-tracheal dysfunctions are predictors of severe feeding disorders. WHAT THIS PAPER ADDS Moebius syndrome frequently induces reduced oral intake and early failure to thrive. Normal oral diet and growth parameters are attained at 2 to 5 years of age. Congenital trismus, pharyngeal palsy, and laryngeal disorders predict dysphagia.
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Affiliation(s)
- Francis Renault
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France
| | | | | | - Bernard Sergent
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique de l'Enfant, Hôpital Necker-Enfants-Malades, Paris, France
| | - Valérie Charpillet
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique de l'Enfant, Hôpital Necker-Enfants-Malades, Paris, France
| | - Françoise Denoyelle
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Service d'Otorhinolaryngologie, Hôpital Necker-Enfants-Malades, Paris, France
| | - Briac Thierry
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Service d'Otorhinolaryngologie, Hôpital Necker-Enfants-Malades, Paris, France
| | - Jeanne Amiel
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Département de Génétique, Hôpital Necker-Enfants-Malades, Paris, France
| | - Cyril Gitiaux
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Service de Neurophysiologie Clinique Pédiatrique, Hôpital Necker-Enfants-Malades, Paris, France
| | - Marie-Paule Vazquez
- Centre de Référence des Fentes et Malformations Faciales 'MAFACE', Hôpital Necker-Enfants-Malades, Paris, France.,Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique de l'Enfant, Hôpital Necker-Enfants-Malades, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris, Paris, France
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9
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Congenital Cranial Dysinnervation Disorder: An Unusual Phenotype With Multiple Cranial Neuropathies and Novel Neuroimaging Findings. J Neuroophthalmol 2019; 39:348-351. [DOI: 10.1097/wno.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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De Stefani E, Nicolini Y, Belluardo M, Ferrari PF. Congenital facial palsy and emotion processing: The case of Moebius syndrome. GENES BRAIN AND BEHAVIOR 2019; 18:e12548. [PMID: 30604920 DOI: 10.1111/gbb.12548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/16/2018] [Accepted: 12/15/2018] [Indexed: 12/13/2022]
Abstract
According to the Darwinian perspective, facial expressions of emotions evolved to quickly communicate emotional states and would serve adaptive functions that promote social interactions. Embodied cognition theories suggest that we understand others' emotions by reproducing the perceived expression in our own facial musculature (facial mimicry) and the mere observation of a facial expression can evoke the corresponding emotion in the perceivers. Consequently, the inability to form facial expressions would affect the experience of emotional understanding. In this review, we aimed at providing account on the link between the lack of emotion production and the mechanisms of emotion processing. We address this issue by taking into account Moebius syndrome, a rare neurological disorder that primarily affects the muscles controlling facial expressions. Individuals with Moebius syndrome are born with facial paralysis and inability to form facial expressions. This makes them the ideal population to study whether facial mimicry is necessary for emotion understanding. Here, we discuss behavioral ambiguous/mixed results on emotion recognition deficits in Moebius syndrome suggesting the need to investigate further aspects of emotional processing such as the physiological responses associated with the emotional experience during developmental age.
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Affiliation(s)
- Elisa De Stefani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ylenia Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mauro Belluardo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pier Francesco Ferrari
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Institut des Sciences Cognitives Marc Jeannerod, CNRS, Université de Lyon, Lyon, France
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11
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Briegel W, Heinzel-Gutenbrunner M, Beate Y. Psychological adjustment of young subjects with Möbius sequence and their primary caregivers' strain and life satisfaction: First longitudinal data. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 85:42-49. [PMID: 30466036 DOI: 10.1016/j.ridd.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/16/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
AIMS/METHODS At present, there is no information about the course of psychological adjustment in young subjects with Möbius sequence (MS) and their parents' strain and life satisfaction. To fill this gap, we performed a four-year follow-up study. Parents were anonymously asked to fill out the Child Behavior Checklist 4-18 [CBCL/ 4-18] or the Young Adult Behavior Checklist 18-30 [YABCL/ 18-30] and the Freiburger Personality Inventory-Revised [FPI-R], subscales strain and life satisfaction. RESULTS 12 males and 14 females (mean: 15.20 years, standard deviation: 3.48 years) could be included in the follow-up (response rate: 83.9%).Compared to the general population, subjects with MS showed significantly higher scores on almost all CBCL scales (exception: externalizing problems) at T1 and T2. At both study times, parental strain and life satisfaction were not significantly different from findings in the general population. No significant longitudinal changes could be found for CBLC scales, parental strain and life satisfaction. CONCLUSIONS Problems with psychological adjustment seem to be frequent among younger subjects with MS. Therefore, careful monitoring as well as early and adequate interventions, if indicated, are crucial for subjects with MS, not only with regard to somatic complaints but also to aspects of adjustment.
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Affiliation(s)
- Wolfgang Briegel
- Department of Child and Adolescent Psychiatry, Psychosomatics & Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics & Psychotherapy, University of Würzburg, Germany.
| | - Monika Heinzel-Gutenbrunner
- Department of Child and Adolescent Psychiatry, Psychosomatics & Psychotherapy, University of Giessen-Marburg, Marburg, Germany
| | - Yvonne Beate
- Department of Child and Adolescent Psychiatry, Psychosomatics & Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany
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12
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Bartzela TN, Carels C, Maltha JC. Update on 13 Syndromes Affecting Craniofacial and Dental Structures. Front Physiol 2017; 8:1038. [PMID: 29311971 PMCID: PMC5735950 DOI: 10.3389/fphys.2017.01038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
Care of individuals with syndromes affecting craniofacial and dental structures are mostly treated by an interdisciplinary team from early childhood on. In addition to medical and dental specialists that have a vivid interest in these syndromes and for whom these syndromes are of evident interest, experts of scientific background-like molecular and developmental geneticists, but also computational biologists and bioinformaticians-, become more frequently involved in the refined diagnostic and etiological processes of these patients. Early diagnosis is often crucial for the effective treatment of functional and developmental aspects. However, not all syndromes can be clinically identified early, especially in cases of absence of known family history. Moreover, the treatment of these patients is often complicated because of insufficient medical knowledge, and because of the dental and craniofacial developmental variations. The role of the team is crucial for the prevention, proper function, and craniofacial development which is often combined with orthognathic surgery. Although the existing literature does not provide considerable insight into this topic, this descriptive review aims to provide tools for the interdisciplinary team by giving an update on the genetics and general features, and the oral and craniofacial manifestations for early diagnosis. Clinical phenotyping together with genetic data and pathway information will ultimately pave the way for preventive strategies and therapeutic options in the future. This will improve the prognosis for better functional and aesthetic outcome for these patients and lead to a better quality of life, not only for the patients themselves but also for their families. The aim of this review is to promote interdisciplinary interaction and mutual understanding among all specialists involved in the diagnosis and therapeutic guidance of patients with these syndromal conditions in order to provide optimal personalized care in an integrated approach.
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Affiliation(s)
- Theodosia N Bartzela
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Berlin, Germany.,Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carine Carels
- Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Jaap C Maltha
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
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13
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Mahrous A, Thalji G. Prosthodontic Management of a Patient with Moebius Syndrome: A Clinical Report. J Prosthodont 2017; 27:299-305. [PMID: 29098745 DOI: 10.1111/jopr.12664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/29/2022] Open
Abstract
Moebius/Mӧbius Syndrome (MS) is an extremely rare congenital disorder characterized by uni- or bilateral palsy of the abducens (VI) and the facial (VII) nerves, causing facial paralysis. Dysfunction of cranial nerves III through XII is common, most often the glossopharyngeal (IX) and hypoglossus (XII). Afflicted individuals seeking prosthodontic care, particularly removable prosthetics, present multiple challenges related to inherent facial and tongue muscle weakness and microstomia. Other extraoral anomalies may include congenital multiple arthrogryposis and malformations of the upper and lower limbs. This clinical report describes the rehabilitation of a patient with Moebius Syndrome using a maxillary 2-implant retained overdenture and mandibular partial removable denture prosthesis.
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Affiliation(s)
- Ahmed Mahrous
- Department of Prosthodontics, University of Iowa, College of Dentistry, Iowa City, IA
| | - Ghadeer Thalji
- Department of Restorative Dentistry, University of Illinois at Chicago, College of Dentistry, Chicago, IL
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Pre- and Postsurgical Orthodontics in Patients with Moebius Syndrome. Case Rep Dent 2017; 2017:1484065. [PMID: 28409036 PMCID: PMC5376922 DOI: 10.1155/2017/1484065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/09/2017] [Indexed: 02/04/2023] Open
Abstract
The authors report a combined orthodontic-surgical correction of an adult patient's malocclusion affected by Moebius Syndrome (MS). The treatment was conducted at the Dentistry Unit and the Maxillofacial Surgery Unit of the University Hospital of Parma. Treatment of malocclusion was performed after the correction of facial mimic mobility with smile surgery. The postoperative stability and orthodontic results were good and the correction of the morphological problems related to the syndrome was very satisfactory.
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Pedersen LK, Maimburg RD, Hertz JM, Gjørup H, Pedersen TK, Møller-Madsen B, Østergaard JR. Moebius sequence -a multidisciplinary clinical approach. Orphanet J Rare Dis 2017; 12:4. [PMID: 28061881 PMCID: PMC5217236 DOI: 10.1186/s13023-016-0559-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/22/2016] [Indexed: 01/31/2023] Open
Abstract
Background Moebius Sequence (MS) is a rare disorder defined by bilateral congenital paralysis of the abducens and facial nerves in combination with various odontological, craniofacial, ophthalmological and orthopaedic conditions. The aetiology is still unknown; but both genetic (de novo mutations) and vascular events in utero are reported. The purpose of present study was through a multidisciplinary clinical approach to examine children diagnosed with Moebius-like symptoms. Ten children underwent odontological, ophthalmological, obstetric, paediatric, orthopaedic, genetic, radiological and photographical evaluation. Five patients maintained the diagnosis of MS according to the diagnostic criteria. Results All five patients had bilateral facial and abducens paralysis confirmed by ophthalmological examination. Three of five had normal brain MR imaging. Two had missing facial nerves and one had missing abducens nerves. The Strengths and Difficulties Questionnaire (SDQ) showed normal scores in three of five patients. Interestingly, two of five children were born to mothers with uterine abnormalities (unicornuate/bicornuate uterus). In the odontological examination three of five showed enamel hypomineralisation. All five had abnormal orofacial motor function and maxillary prognathism. Two patients had adactyly, syndactyly and brachydactyly. None of the five patients had Poland anomaly, hip dislocation or dysplasia but all had a mild degree of scoliosis. We observed congenital club-feet, calcaneovalgus deformities, macrodactyly of one or more toes or curly toes. Pedobarography showed plantar pressures within normal ranges. Conclusions Adherence to standard diagnostic criteria is central in the diagnosis of MS. An accurate diagnosis is the basis for correct discussion of other relevant concomitant symptoms of MS, genetic testing and evaluation of prognosis. The multidisciplinary approach and adherence to diagnostic criteria taken in present study increases the knowledge on the relationship between genotype, phenotype and symptomatology of MS.
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Affiliation(s)
- Line Kjeldgaard Pedersen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. .,Department of Childrens Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Gynaecology-Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Hans Gjørup
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Klit Pedersen
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Bjarne Møller-Madsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Childrens Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Fairgray E, Miles A. Enhancing surgical outcomes: The effects of speech therapy on a school-aged girl with Moebius Syndrome. Int J Pediatr Otorhinolaryngol 2016; 90:58-62. [PMID: 27729154 DOI: 10.1016/j.ijporl.2016.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Moebius Syndrome is a rare congenital neurological condition often characterized by multiple cranial nerve involvement. This case study presents an eight-year old girl with Moebius Syndrome (MC) who received 30 sessions of speech therapy. This occurred after presenting to clinic 11 months after left facial reanimation with gracilis thigh muscle transfer surgery. On examination, only flickers of left facial movement were observed. There was no movement on the right side of the face. As a consequence of the minimal movement, MC presented with drooling and unintelligible speech. The purpose of speech therapy was three fold: minimise the pooling of saliva, improve the placement of the articulators so that articulation of speech sounds would be more accurate, and gain advances in overall intelligibility. METHODS Therapy focussed on speech, facial movement and saliva management using a combination of speech drills, evidence-based articulation therapies, facial exercises with surface electromyography biofeedback, self-awareness training and compensatory saliva management strategies. RESULTS After a course of 30 one-hour speech therapy sessions, substantial improvements were seen in speech sound accuracy, overall intelligibility, facial movement and saliva control. CONCLUSIONS The combination of surgery and speech therapy led to functional gains that surgery alone did not achieve. The impact of speech therapy on surgical outcomes in individuals with Moebius syndrome deserves further investigation.
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Affiliation(s)
| | - Anna Miles
- Speech Science, The University of Auckland, New Zealand.
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Martins Mussi MC, Moffa E, Castro T, Lira Ortega A, Freitas G, Braga M, Siqueira WL, Cury Gallottini MH. Salivary parameters and oral health in the Moebius syndrome. SPECIAL CARE IN DENTISTRY 2016; 36:265-70. [PMID: 27061084 DOI: 10.1111/scd.12175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate salivary characteristics, such as flow rate, buffering capacity and amylase activity, and associate these parameters with oral health in individuals with Moebius syndrome (MS) and controls. METHODS The researchers assessed caries (ICDAS), periodontal disease (PSR), and plaque (Silness Löe) indexes in both groups. Unstimulated, stimulated, and bilateral parotid saliva were also collected. The salivary flow (milliliters/minute) and α-amylase activity were measured in all samples. The α-amylase activity was determined by maltose production. The buffering capacity was measured in stimulated saliva by titration of 0.01N HCl. RESULTS The occurrence of carious lesions, related to cut-off 2, as well as the occurrence of periodontal disease, was significantly higher (p > 0.05) in participants with MS when compared to the control group. Also, MS individuals presented decreased salivary flow, decreased buffering capacity, and amylase activity. CONCLUSIONS MS individuals present salivary alterations, which can be related to higher risk for caries.
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Affiliation(s)
- Maria Carolina Martins Mussi
- Researcher, Department of Oral Pathology and Special Patients, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | | | - Talita Castro
- PhD student, Department of Oral Pathology and Special Patients, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Adriana Lira Ortega
- Postdoctoral researcher, Department of Oral Pathology and Special Patients, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Gabrielle Freitas
- Undergraduate student, Department of Oral Pathology and Special Patients, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Mariana Braga
- Professor, Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Walter L Siqueira
- Professor, Department of Biochemistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Marina Helena Cury Gallottini
- Professor, Department of Oral Pathology and Special Patients, School of Dentistry, University of São aulo, São Paulo, Brazil
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Sjögreen L, Eklund K, Nilsson A, Persson C. Speech production, intelligibility and oromotor function in seven individuals with Möbius sequence. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:537-544. [PMID: 25833072 DOI: 10.3109/17549507.2015.1016108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Möbius sequence is a rare disease characterized by congenital facial and abducent nerve palsy. Other cranial nerves may be affected. Cleft palate, intellectual disability and neuropsychiatric disorders are associated with the diagnosis. The aim was to explore speech production, intelligibility and oromotor function in a group of individuals with Möbius sequence. METHOD Three children (5-11 years) and four adults (26-54 years) were recruited to the study via the Swedish Möbius syndrome association. In addition to cranial nerve dysfunction, two had a hearing impairment, one Asperger syndrome and one a cleft palate. Perceptual assessments included an evaluation of intelligibility in single words and spontaneous speech, the percentage of phonemes correct (PPC) and screening of orofacial functions (NOT-S). Objective measurements were used for the evaluation of nasality, lip force and tongue force. RESULT Three individuals had severely impaired intelligibility, two slightly impaired and two had fully intelligible speech. The PPC varied between 59.3-100%. Five individuals had bilateral facial palsy, two unilateral facial palsy and six tongue impairment. One had a slightly increased nasalance score. Compensatory strategies were being effectively used. CONCLUSION This case series contributes more in-depth knowledge of speech production, intelligibility and oromotor function in this rare condition.
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Affiliation(s)
- Lotta Sjögreen
- a Mun-H-Center Orofacial Resource Centre for Rare Diseases, Public Dental Service , Västra Götaland Region, Gothenburg , Sweden
| | - Kajsa Eklund
- b Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Anna Nilsson
- b Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Christina Persson
- b Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg , Sweden
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Perspectives in the reconstruction of paediatric facial paralysis. Curr Opin Otolaryngol Head Neck Surg 2015; 23:470-9. [DOI: 10.1097/moo.0000000000000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sjögreen L, Mogren Å, Andersson-Norinder J, Bratel J. Speech, eating and saliva control in rare diseases - a database study. J Oral Rehabil 2015; 42:819-27. [PMID: 26094963 DOI: 10.1111/joor.12317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 12/21/2022]
Abstract
The aim was to study the background to and the manifestations of affected intelligibility of speech and reported difficulty with eating and saliva control in rare diseases. In Sweden, a disease or disorder is defined as rare when it affects no more than 100 individuals per million population and leads to a marked degree of disability. In 1996-2008, 1703 individuals with 169 rare diseases (3-67 years) answered a questionnaire about oral health and oro-facial function and 1614 participated in a clinical examination. A control group of 135 healthy children was included. Oromotor impairment was a frequent finding (43%) and was absent among the controls. Half the children in the youngest age group (3-6 years) had moderate/severely affected intelligibility or no speech compared with one-third in the other age groups. The most frequent eating difficulties were related to chewing and were found in approximately 20% of the individuals in the study group. Artificial nutrition was most common in children aged 3-6 years (9·2%), followed by children aged 7-12 years (4·9%), adolescents aged 13-19 years (3·3%) and adults (1·4%). Impaired saliva control was common (31·2%) and strongly and significantly correlated with oromotor dysfunction, intellectual disability, open mouth at rest and epilepsy. In conclusion, oromotor impairment and oro-facial dysfunctions, such as affected intelligibility, eating difficulties and impaired saliva control, are frequent in individuals with rare diseases. There is a strong correlation between oromotor impairment and affected intelligibility, eating difficulties and impaired saliva control in individuals with rare diseases.
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Affiliation(s)
- L Sjögreen
- Mun-H-Center Orofacial Resource Center for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Å Mogren
- Mun-H-Center Orofacial Resource Center for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - J Andersson-Norinder
- Mun-H-Center Orofacial Resource Center for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - J Bratel
- Special Care Dentistry/Clinic of Oral Medicine, Odontologen, Public Dental Service, Gothenburg, Sweden
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Pradhan A, Gryst M. Atraumatic restorative technique: case report on dental management of a patient with Moebius syndrome. Aust Dent J 2015; 60:255-9. [PMID: 25989267 DOI: 10.1111/adj.12319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical challenges associated with Moebius syndrome, a rare congenital neuromuscular disorder, include orofacial anomalies like microstomia, limited mouth opening and severe gag reflex. METHODS This case report presents the dental management of an anxious female with Moebius syndrome. For restorations, atraumatic restorative technique (ART), using glass ionomer cement was used with hand instruments. RESULTS All necessary dental treatment was completed in the dental chair, thus avoiding the need for a general anaesthetic, and associated complications with airway management due to orofacial abnormalities. CONCLUSIONS ART is an appropriate technique for people with microstomia and/or limited mouth opening, such as those with Moebius syndrome. The application of ART can be extended to other special needs patients (people with physical and intellectual disabilities, extreme anxiety, needle phobia and the frail elderly in aged care facilities), where access or cooperation is difficult or limited.
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Affiliation(s)
- A Pradhan
- Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.,Special Needs Unit, Adelaide Dental Hospital, Adelaide, South Australia
| | - M Gryst
- Special Needs Unit, Adelaide Dental Hospital, Adelaide, South Australia
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Matsui K, Kataoka A, Yamamoto A, Tanoue K, Kurosawa K, Shibasaki J, Ohyama M, Aida N. Clinical characteristics and outcomes of Möbius syndrome in a children's hospital. Pediatr Neurol 2014; 51:781-9. [PMID: 25306435 DOI: 10.1016/j.pediatrneurol.2014.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Möbius syndrome is a congenital disorder with facial and abducens palsy. Although a few case series studies have examined comorbid conditions in Möbius syndrome, follow-up and outcome data are sparse. OBJECTIVES To examine the clinical characteristics and outcomes of Möbius syndrome. METHODS Clinical data were reviewed for 10 patients. Neonatal history, neurological examination, comorbid anomalies, medical home care, outcomes, and neuroimaging were summarized. RESULTS The patients' mean age was 7.3 ± 6.2 years. On neurological examination, absent blink reflex, jaw ankylosis, absent gag reflex, and tongue atrophy were frequently observed. Poland anomaly and clubfoot were present in three and six patients, respectively. Specific therapies required for patients included medical home care (six patients), suction apparatus (six), tube feeding (five), gastrostomy (two), tracheostomy (three), oxygen therapy (three), and home ventilator (two). Punctate calcification in the brainstem was observed in four patients. Pontine and medulla hypoplasia were detected on the basis of anteroposterior diameter in four and seven patients, respectively. Two patients had congenital hydrocephalus with aqueductal stenosis. Global developmental delay occurred in five patients. Three patients died. CONCLUSION The rate of both the use of home medical devices and death was high in our patients. Möbius syndrome is extremely diverse, not only in clinical manifestation, but also outcome. Early multidisciplinary intervention is important to ensure an optimal outcome. Aqueductal stenosis is an occasional comorbid anomaly resulting from midbrain abnormality.
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Affiliation(s)
- Kiyoshi Matsui
- Division of General Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan; Division of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan.
| | - Ai Kataoka
- Division of General Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Atsuko Yamamoto
- Division of General Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Koji Tanoue
- Division of General Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Kenji Kurosawa
- Division of Medical Genetics, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Jun Shibasaki
- Division of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Makiko Ohyama
- Division of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Noriko Aida
- Division of Radiology, Kanagawa Children's Medical Center, Kanagawa, Japan
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Jacob FD, Kanigan A, Richer L, El Hakim H. Unilateral Möbius syndrome: two cases and a review of the literature. Int J Pediatr Otorhinolaryngol 2014; 78:1228-31. [PMID: 24951398 DOI: 10.1016/j.ijporl.2014.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/22/2014] [Accepted: 05/25/2014] [Indexed: 11/16/2022]
Abstract
IMPORTANCE The Möbius sequence is a rare condition defined by the combination of congenital non-progressive facial and abducens nerve palsies. The etiology of the sequence is still unknown, but likely encompasses a group of heterogeneous disorders involving genetic maldevelopment of the brainstem, a fetal vascular insult and/or teratogen exposure. The clinical phenotype reported has expanded over the years, and may be associated with more extensive cranial nerve and oropharyngeal involvement, as well as limb defects. OBSERVATIONS We describe two cases of children presenting with unilateral Möbius syndrome associated with ipsilateral unilateral palatal weakness. Investigations failed to identified a clear underlying etiology, but both cases shared phenotypic features of other more common cranial facial disorders such as craniofacial microsomia and the velocardiofacial syndrome. CONCLUSION AND RELEVANCE These two cases highlight the clinical heterogeneity of the Möbius sequence. Although asymmetries are not uncommon, cases with strictly unilateral features are extremely rare, and as such these may represent a distinct subgroup that may pertain to a specific etiology. Although in many cases, evidence of an intrauterine vascular insult may be identified, a contributing genetic etiology should be considered, even in cases with strictly unilateral features. As such genes expressed in the developing rhombencephalon and its vasculature represent good candidates for future investigation.
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Affiliation(s)
- F D Jacob
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - A Kanigan
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - L Richer
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - H El Hakim
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Divisions of Otolaryngology and Pediatric Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Samsudin WSW, Sundaraj K. Clinical and non-clinical initial assessment of facial nerve paralysis: A qualitative review. Biocybern Biomed Eng 2014. [DOI: 10.1016/j.bbe.2014.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morales-Chávez M, Ortiz-Rincones MA, Suárez-Gorrin F. Surgical techniques for smile restoration in patients with Möbius syndrome. J Clin Exp Dent 2013; 5:e203-7. [PMID: 24455082 PMCID: PMC3892243 DOI: 10.4317/jced.51116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/14/2013] [Indexed: 01/08/2023] Open
Abstract
Möbius syndrome is a congenital condition, the etiology when is not associated with misoprostol is not well defined. Signs and symptoms include difficulty swallowing, speech problems, drooling, strabismus, limitation of eye movement and more importantly, the facial blankness that these individuals have, result of the facial paralysis, due to atrophy of the cranial nerves that are involved in this condition. The ability to express emotions is affected and are considered “children without a smile.” There is currently no treatment to solvent the birth defects, the treatment options for reduce these alterations is the surgical option that has as main objective to restore muscle function through various techniques, used as required, the possibilities of applying them, is taking into consideration the outcome of the procedure to execute. Among the surgical techniques used mainly: the lengthening myoplasty of the temporal muscle,muscle transfers, cross-facial grafting, neurorrhaphy and nerve transposition, of which latter are the best performers, giving the patient a more natural, in as far as regards expression and function.
Key words:Möbius syndrome, surgery, smile, facial nerve, muscle transfer, transfer nerve, temporalis muscle.
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Affiliation(s)
- Mariana Morales-Chávez
- Pediatric Dentist. Magister in Special Care Dentistry. Director of Dental Research Center. Dental School, Santa María University Caracas, Venezuela
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Ortega ADOL, Marques-Dias MJ, Santos MTBRD, Castro T, Gallottini M. Oral motor assessment in individuals with Moebius syndrome. J Oral Pathol Med 2013; 43:157-61. [PMID: 23930941 DOI: 10.1111/jop.12107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Moebius syndrome (MS) is a rare congenital condition that is characterised by facial hypomimia and congenital strabismus caused by complete or partial impairment of the 6th and 7th cranial nerves. MS may be further associated with other nerves or malformations, mainly involving the extremities. The objective of this study was to quantify the decrease in oral motor performance in people with MS compared with normoreactive individuals using the Oral Motor Assessment Scale (OMAS). METHODS The study group comprised 33 subjects between the ages of 2 and 20 years (average age: 10 ± 5 years) with MS along with 46 age- and gender-matched control subjects. RESULTS The study group displayed a lower average functional score than the control group (P < 0.0001). A significant lack of lip closure (P = 0.03) and anterior lingual seal during swallowing (P = 0.03) occurred in the study group; in most cases, the individuals with MS were classified as 'subfunctional'. In addition, individuals with MS in the older age group displayed better functional scores than those in the younger group (P = 0.05). CONCLUSIONS Functional damage to oral motor function in individuals with MS is evident, but differs among patients with respect to severity and the movements that are compromised. However, overall, improvements in the functional patterns of these individuals can be observed as they mature in age.
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Affiliation(s)
- Adriana de Oliveira Lira Ortega
- Department of Oral Pathology, Special Care Dentistry Center, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Facial palsy in individuals with thalidomide embryopathy: frequency and characteristics. The Journal of Laryngology & Otology 2013; 126:902-6. [PMID: 22892220 DOI: 10.1017/s0022215112001429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Earlier studies have shown that individuals with thalidomide embryopathy can have skeletal deformities, ear and eye aberrations, and facial palsy. This study aimed to survey the frequency and characteristics of facial palsy in this group of individuals. PARTICIPANTS Thirty-one individuals with thalidomide embryopathy (age range, 45-47 years) and 25 healthy adults (age range, 41-56 years; mean age ± standard deviation, 49 ± 4.2 years). MAIN OUTCOME MEASURES Voluntary facial movements, lip force and three-dimensional lip motion analysis. RESULTS AND CONCLUSION Four of the thalidomide embryopathy individuals (13 per cent) had congenital facial palsy. All four had eye aberrations, three had ear anomalies and one had a limb anomaly. Individuals with thalidomide embryopathy without a clinical diagnosis of facial impairment had significantly weaker lips and more restricted lip mobility than healthy controls. This study contributes to the overall knowledge of thalidomide embryopathy by adding a description of how facial expression can be affected in this condition.
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Management of maxillofacial hard and soft tissue discrepancy in Möbius sequence: Clinical report and review of the literature. J Craniomaxillofac Surg 2012; 40:11-6. [DOI: 10.1016/j.jcms.2010.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/29/2010] [Accepted: 12/28/2010] [Indexed: 11/20/2022] Open
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Briegel W. Self-perception of children and adolescents with Möbius sequence. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:54-59. [PMID: 22093648 DOI: 10.1016/j.ridd.2011.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/15/2011] [Indexed: 05/31/2023]
Abstract
Möbius sequence is a rare congenital disorder usually defined as a combination of facial weakness with impairment of ocular abduction. Some studies suggest that psychosocial and psychiatric problems might be increased among affected persons. So far, there have been no studies on the self-perception of children and adolescents with the sequence. Seventeen participants with Möbius sequence (9 male, 8 female) aged 9-15 (mean: 11.59) years were studied. None of the probands was mentally retarded or had a diagnosis of autism spectrum disorder. Participants filled out well standardized German questionnaires on depression (Depressionsinventar für Kinder und Jugendliche [DIKJ]), anxiety (Angstfragebogen für Schüler [AFS]) and personality aspects (Persönlichkeitsfragebogen für Kinder von 9-14 Jahren [PFK 9-14]). Additionally, their primary caregivers were asked to complete a special questionnaire to compile the probands' personal, somatic and psychosocial history as well as the German version of the Strengths and Difficulties Questionnaire, Parent Form [SDQ-Deu]. According to the participants' self-perception only one girl scored clinical (t-score ≥ 63) for manifest anxiety [AFS] and depression [DIKJ] (5.9% vs. 10% in the general population). Moreover, the whole sample reported significantly lower test anxiety (p=0.000) and manifest anxiety (p=0.005) [AFS] whereas general anxiety as a personality aspect [PFK 9-14] did not differ from the normative sample. Compared to normative data, subjects expressed significantly less depression (p=0.023) and impulsivity (p=0.042). One out of 17 subjects was rated abnormal for total problems on the SDQ-Deu (5.9% vs. 10% of the normative sample), five participants scored abnormal for social problems (29.4%) and three for emotional problems (17.6%). Social problems correlated significantly with the probands' age (rho=0.707; p=0.002). As Möbius patients have severe difficulties with facial expression of feelings, and others might therefore falsely recognize them as serious or even depressed, the subjects' self-perception is crucial for assessment and diagnosis, especially if it differs considerably from that of the primary caregivers.
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Affiliation(s)
- Wolfgang Briegel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany.
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The expression and assessment of emotions and internal states in individuals with severe or profound intellectual disabilities. Clin Psychol Rev 2011; 31:293-306. [PMID: 21382536 DOI: 10.1016/j.cpr.2011.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/05/2011] [Accepted: 01/06/2011] [Indexed: 11/20/2022]
Abstract
The expression of emotions and internal states by individuals with severe or profound intellectual disabilities is a comparatively under-researched area. Comprehensive or standardized methods of assessing or understanding the emotions and internal states within this population, whose ability to communicate is significantly compromised, do not exist. The literature base will be discussed and compared to that applicable to the general population. Methods of assessing broader internal states, notably depression, anxiety, and pain within severe or profound intellectual disabilities are also addressed. Finally, this review will examine methods of assessing internal states within genetic syndromes, including hunger, social anxiety, and happiness within Prader-Willi, Fragile-X and Angelman syndrome. This will allow for identification of robust methodologies used in assessing the expression of these internal states, some of which may be useful when considering how to assess emotions within individuals with intellectual disabilities.
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Briegel W, Schimek M, Kamp-Becker I. Moebius sequence and autism spectrum disorders--less frequently associated than formerly thought. RESEARCH IN DEVELOPMENTAL DISABILITIES 2010; 31:1462-1466. [PMID: 20621443 DOI: 10.1016/j.ridd.2010.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/11/2010] [Indexed: 05/29/2023]
Abstract
Moebius sequence is a rare congenital disorder usually defined as a combination of facial weakness with impairment of ocular abduction. It is questionable, whether there is a strong association of the sequence with autism spectrum disorders (ASDs) as suggested in some earlier case reports and studies. Twenty-two participants with Möbius sequence aged 6-16 years followed a request of the German Moebius foundation to participate in a nationwide study. All patients had a physical examination and intelligence testing. Primary caregivers were asked to complete two screening measures of ASD (Behaviour and Communication Questionnaire, VSK; Marburger Asperger's Syndrome Rating Scale, MBAS). For those who reached the cut-off for ASD and/or showed behavioural aspects indicative of ASDs during IQ testing and/or physical examination, well standardized diagnostic instruments (Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, and Kinder-DIPS) were administered. Minimal diagnostic criteria for Möbius sequence were congenital facial weakness (uni- or bilateral) and impairment of ocular abduction (uni- or bilateral). Three boys (one of them mentally retarded) out of 22 participants (12 males and 10 females) were found suspicious of ASD by screening, but none of them fulfilled diagnostic criteria of ASD on a clinical consensus conference. Therefore, ASDs seem to be not as frequent as reported in previous studies on patients with Möbius sequence.
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Affiliation(s)
- Wolfgang Briegel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany.
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Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna E. Facial animation in patients with Moebius and Moebius-like syndromes. Int J Oral Maxillofac Surg 2010; 39:1066-73. [DOI: 10.1016/j.ijom.2010.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 05/19/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
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Almeida JRD, Alexander AJ, Shrime MG, Gilbert RW, Goldstein DP. Development and preliminary validation of the Lip Reanimation Outcomes Questionnaire. Otolaryngol Head Neck Surg 2010; 143:361-6. [DOI: 10.1016/j.otohns.2010.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 05/09/2010] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE: Lip paralysis is associated with eating, speaking, and appearance impairments. The lip reanimation outcome questionnaire is designed to assess these functional impairments after lip reanimation. STUDY DESIGN: Cross-sectional validation study. SETTING: Tertiary care academic center. SUBJECTS AND METHODS: Patients who underwent lip reanimation and control subjects. A disease-specific instrument was created by systematic literature review and expert opinion. The 15-item patient completed subscale was administered to 20 lip reanimation patients. Photographs of 19 patients and three control subjects were taken in four poses and rated by six raters (2 surgeons, 2 residents, and 2 novices) by the use of a external rater subscale, and reliability was determined by the use of intraclass correlation coefficients (ICC). Content and construct validity were assessed. RESULTS: Internal consistency (ICC range 0.813-0.915 for each domain), test—retest reliability (ICC range 0.616-0.981 for each item) for the patient completed subscale, and interrater (ICC = 0.852) and interlevel reliability (ICC = 0.929) for the external rater subscale were substantial to excellent. The content validity index was 0.87. Construct validity was demonstrated by poorer scores in patients with transected nerves versus intact nerves for appearance ( P = 0.04) and oral competence ( P = 0.011). Photographs of control patients had lower asymmetry scores ( P < 0.001), and the instrument detected greater asymmetry in patients with progressively more exaggerated smile ( P < 0.001). CONCLUSION: The lip reanimation outcome questionnaire has promising reliability and validity in this preliminary study, but additional psychometric testing with larger samples is required before the survey can be recommended for clinical use. © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- John R. de Almeida
- From the Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ashlin J. Alexander
- From the Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mark G. Shrime
- From the Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W. Gilbert
- From the Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P. Goldstein
- From the Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada
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Briegel W, Hofmann C, Schwab KO. Behaviour problems of patients with Moebius sequence and parental stress. J Paediatr Child Health 2010; 46:144-8. [PMID: 20105253 DOI: 10.1111/j.1440-1754.2009.01652.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Moebius sequence is a rare condition usually defined as congenital facial paralysis with congenital impairment of ocular abduction. At present, there is little information on behavioural problems, parental stress and possible relationships between these factors. To fill this gap, this study investigated these aspects relevant for counselling. METHODS Parents of 4-17 year old subjects known to the German Möbius syndrome foundation were anonymously asked to fill out several questionnaires, for example, the Child Behavior Checklist (CBCL)4-18. RESULTS The primary care givers of 41/58 subjects (70.7%) sent back filled-out questionnaires. Ten subjects did not meet the inclusion criteria; 15 males and 16 females (4; 7-17; 0 years, median age: 10; 7 years) were included. Ten out of 31 subjects were rated as clinical on at least one CBCL scale; three had a total problem score in the clinical range. Social problems were the most important problems with rates of 12-17-year old subjects being about five times as high as those of younger subjects. Compared with the general population, but not with other parents of mentally and/or physically handicapped children, the primary care givers experienced higher levels of stress, which were correlated to anxious/depressed behaviour, aggressive behaviour, externalising problems and total problem score of the children. The older a child the higher the primary care giver's life satisfaction was. CONCLUSIONS Social problems seem to be frequent among 4-17-year old subjects with Moebius sequence, and primary care givers show increased strain. Therefore, families with an affected child need early and adequate support.
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Affiliation(s)
- Wolfgang Briegel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Leopoldina Hospital, Schweinfurt, Germany.
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Kramer FJ, Gruber R, Fialka F, Sinikovic B, Hahn W, Schliephake H. Quality of life in school-age children with orofacial clefts and their families. J Craniofac Surg 2010; 20:2061-6. [PMID: 19881367 DOI: 10.1097/scs.0b013e3181be8892] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nonsyndromic orofacial clefts might affect family functioning and probably reduce the quality of life in school-age children and their parents. One hundred seventy consecutive children with orofacial clefts between 8 and 12 years and their families were asked to answer the Impact on Family Scale and KINDL. The results were compared with the quality of life in an age- and sex-matched group of unaffected schoolchildren. One hundred thirty-two families participated in this study. Family functioning was found superior in families with children with cleft lip than in families with children with cleft palate only or cleft lip and palate. Sex had no significant influence on family functioning. The quality of life in schoolchildren with orofacial clefts was found superior to the control group. Reductions were observed in children with cleft lip and palate in the dimensions "family" and "friends," indicating problems in the social field. Boys with orofacial clefts experienced a lower quality of life than girls. Children with cleft lip and palate and cleft palate only experienced a lower quality of life than children with cleft lip. Even years after successful cleft reconstruction, coping and mastering the diagnosis of orofacial cleft is a relevant concern for affected families. Several limitations of the quality of life in schoolchildren were identified, mostly affecting their social role.
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Affiliation(s)
- Franz-Josef Kramer
- Department of Plastic Oral and Maxillofacial Surgery, George-August-University of Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany.
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Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna E. Facial animation in children with Moebius and Moebius-like syndromes. J Pediatr Surg 2009; 44:2236-42. [PMID: 19944241 DOI: 10.1016/j.jpedsurg.2009.07.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/21/2009] [Accepted: 07/18/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Moebius syndrome, a rare congenital disorder of varying severity, involves multiple cranial nerves and is characterized predominantly by bilateral or unilateral paralysis of the facial and abducens nerves. The paralysis of the VI and VII cranial nerves leads to a lack of function in the muscles they supply. 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. METHODS In this study, we report on pediatric patients with Moebius and Moebius-like syndromes seen and treated surgically from 2003 to September 2007 at the Operative Unit of Maxillofacial Surgery, Head and Neck Department, University of Parma, Italy. RESULTS Twelve patients underwent microsurgical reconstruction for restoration of facial movement. The contralateral facial nerve was used as a motor donor nerve in 4 procedures, the motor nerve to the masseter muscle was used in 8 patients, and the gracilis muscle was used in all operations, with a total of 17 free-muscle transplantations. All free-muscle transplantations survived transfer, and no flap was lost. We observed a significant improvement in drooling, drinking, speech, and facial animation with a high degree of patient satisfaction. CONCLUSIONS The gracilis muscle free transfer is a surgical procedure well tolerated by the young patients and well accepted by their families. We consider it a safe and reliable technique for facial reanimation with good aesthetical and functional results in children with Moebius and Moebius-like syndromes.
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Affiliation(s)
- Bernardo Bianchi
- Maxillofacial Surgery, Head and Neck Department, University of Parma, 14-43100 Parma, Italy
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Briegel W, Schimek M, Kamp-Becker I, Hofmann C, Schwab KO. Autism spectrum disorders in children and adolescents with Moebius sequence. Eur Child Adolesc Psychiatry 2009; 18:515-9. [PMID: 19255803 DOI: 10.1007/s00787-009-0003-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 01/23/2009] [Indexed: 11/27/2022]
Abstract
Moebius sequence is a rare congenital disorder usually defined as a combination of facial weakness with impairment of ocular abduction. A strong association of Moebius sequence with autism spectrum disorders (ASDs) has been suggested in earlier studies with heterogenous age groups. The primary caregivers of all children and adolescents with Moebius sequence aged 6-17 years known to the German Moebius foundation were anonymously asked to complete two screening measures of ASD [Behavior and Communication Questionnaire (VSK); Marburger Asperger's Syndrome Rating Scale (MBAS)]. For those who reached the cut-off for ASD, well standardized diagnostic instruments (Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, WISC-III, and Kinder-DIPS) should be administered. Minimal diagnostic criteria for Moebius sequence were congenital facial weakness (uni- or bilateral) and impairment of ocular abduction (uni- or bilateral). Familiar cases should be excluded. The primary caregivers of 35/46 children and adolescents (18 males, 17 females, mean age 11.5 years) sent back completed questionnaires, but only 27 subjects met inclusion criteria. According to the primary caregivers, none of these subjects showed mental retardation. Two probands (both males 9 and 16 years old) reached the cut-off of the MBAS whereas the results of the VSK did not indicate ASDs in any of the patients. The 9 year old boy could be examined personally and did not meet diagnostic criteria of ASD. ASDs might be not as frequent as reported in previous studies on patients with Moebius sequence, at least not in patients without mental retardation.
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Affiliation(s)
- Wolfgang Briegel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Leopoldina Hospital, Gustav-Adolf-Str. 4, Schweinfurt 97422, Germany.
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Quality of life and family functioning in children with nonsyndromic orofacial clefts at preschool ages. J Craniofac Surg 2008; 19:580-7. [PMID: 18520368 DOI: 10.1097/scs.0b013e31816aaa43] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Children with orofacial clefts (OFC) at preschool ages may have to tolerate psychosocial disadvantages due to their altered speech and facial appearance probably affecting their quality of life (QoL) and family functioning. In 147 children with OFC aged between 5 and 6 years and their families, the QoL and family functioning were analyzed using the KINDL questionnaire for measuring health-related QoL in children and impact on family scale. The KINDL scores were lowest in the dimension self-esteem. In all dimensions, the KINDL scores of children were higher than those of the parents suggesting a superior QoL than the caregivers estimated (P<0.001). In affected families, the impact on family scale dimensions personal impact and impact on coping strategies were found highest. Families having children with isolated cleft lip or cleft lip and palate had higher impacts on coping strategies when compared with children having isolated cleft palate (P<0.041). The impact for siblings (P<0.02) was found highest in patients with cleft lip and palate. In all examined dimensions, children with OFC perceived a higher QoL than their caregivers expected. However, self-esteem seems to be problematic in all types of OFC and in both genders. Knowledge of potential impacts related to the type of cleft and the gender of the patient will probably facilitate health care professionals to identify children and families at high risk to experience a reduced QoL and may help to offer specific support and treatment strategies.
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Scarpelli AC, Vertchenko TB, Resende VLS, Castilho LS, Paiva SM, Pordeus IA. Möbius Syndrome: A Case with Oral Involvement. Cleft Palate Craniofac J 2008; 45:319-24. [DOI: 10.1597/07-084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Möbius syndrome is a rare congenital condition that is characterized clinically by paralysis of a group of cranial nerves. It presents diverse manifestations that can have negative repercussions on the quality of life of affected individuals. This article presents a clinical case of a child with the syndrome and addressed the clinical manifestations and difficulties experienced during dental treatment. Knowledge of the etiopathological aspects and clinical manifestations of the condition is essential to perfecting treatments that aim to improve the quality of life of such individuals and their families.
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Affiliation(s)
- Ana Carolina Scarpelli
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Lia Silva Castilho
- Department of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isabela Almeida Pordeus
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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An analysis of quality of life in 130 families having small children with cleft lip/palate using the impact on family scale. Int J Oral Maxillofac Surg 2007; 36:1146-52. [DOI: 10.1016/j.ijom.2007.06.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 02/25/2007] [Accepted: 06/15/2007] [Indexed: 11/21/2022]
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Abstract
Möbius sequence is a rare condition of heterogeneous, and in most cases, unclear; origin, usually defined as a unilateral or bilateral congenital facial weakness with impairment of ocular abduction, which is frequently associated with limb anomalies. Disturbances in psychomotor and speech development are very common, and mental retardation is estimated to occur in 10-15% of cases. The incidence of autistic spectrum disorders might be increased in patients with Möbius sequence. After a brief overview on aetiology and physical appearance, current knowledge of cognitive capacities and academic achievement; psychomotor development; development of speech, language and communication; behaviour problems; psychiatric comorbidity and possible therapeutic interventions are reviewed.
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Affiliation(s)
- W Briegel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Bezirkskrankenhaus Passau, Passau, Germany.
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Miller MT, Strömland K, Ventura L, Johansson M, Bandim JM, Gillberg C. Autism associated with conditions characterized by developmental errors in early embryogenesis: a mini review. Int J Dev Neurosci 2004; 23:201-19. [PMID: 15749246 DOI: 10.1016/j.ijdevneu.2004.06.007] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Revised: 06/17/2004] [Accepted: 06/21/2004] [Indexed: 11/24/2022] Open
Abstract
Autism is a complex developmental disorder without an established single etiology but with significant contributions from genetic studies, functional research, and neuropsychiatric and neuroradiologic investigations. The purpose of this paper is to review the findings in five studies involving individuals manifesting the characteristic findings of autism spectrum disorder associated with malformations and dysfunctions known to result from early embryogenic defects. These investigations include two associated with teratogens (thalidomide embryopathy, Mobius sequence with misoprostol) and three (most Mobius sequence cases, CHARGE association, Goldenhar syndrome) with no known etiology. These studies suggest that early embryonic development errors often involving cranial nerve palsies, internal and external ear malformations, ophthalmologic anomalies, and a variety of systemic malformations may be associated with autism spectrum disorders statistically more frequently than expected in a normal population. Although the exact time of developmental insult for each condition cannot be identified, the evidence is that it may occur as early as week 4 to 6+ of embryogenesis.
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Affiliation(s)
- Marilyn T Miller
- Department of Ophthalmology and Visual Sciences, University of Illinois, 1855 West Taylor Street, Rm. 327, Chicago, IL 60612, USA.
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Abstract
Congenital disorders of the brainstem often result in multiple severe neurodevelopmental problems. With the advent of magnetic resonance imaging and discovery of genes directing brainstem formation, a more coherent clinical picture of these disorders is emerging. Proper evaluation, management, and counseling for these disorders rests on the clinician having a framework through which to approach them.
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Affiliation(s)
- Laurence Walsh
- Child Neurology Section, Riley Hospital for Children, Indianapolis, IN 46202, USA
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