Treatment and Prognosis
TREATMENT
There is no specific treatment for Möbius syndrome. Treatment is supportive and depends on the symptoms present. Some infants need feeding tubes to get proper nutrition. Surgery is indicated in patients with crossed eyes and limb and jaw deformities to correct these problems. Symptoms indicating speech complications are usually treated with physical and speech therapy to improve patients' motor skills and coordination to improve speech and eating capabilities. For some patients, plastic reconstructive surgery is indicated. Some advancements have been made in improving the ability to smile with nerve and muscle transfers to the corners of the mouth (NINDS, 2011). Some hospitals offer Facial Reanimation Programs that treat all aspects of facial nerve paralysis and peresis (Boston Childrens Hospital). All surgical care is symptomatic or cosmetic but it is not curative of the underlying syndrome (Palmer et al, 2012). Each treatment plan is designed based on the patient's individual symptoms of the syndrome.
PROGNOSIS
There is no cure for Möbius syndrome due to the fact that it is a development disorder of the cranial nerved 6 and 7. However, individuals generally have a normal life expectancy with normal care and treatment despite the impairments that characterize the disorder. The disorder is overall static, but improvement with age has been observed. In severe cases, respiratory complications may lead to infant death or mortality (Palmer et al. 2012).
There is no specific treatment for Möbius syndrome. Treatment is supportive and depends on the symptoms present. Some infants need feeding tubes to get proper nutrition. Surgery is indicated in patients with crossed eyes and limb and jaw deformities to correct these problems. Symptoms indicating speech complications are usually treated with physical and speech therapy to improve patients' motor skills and coordination to improve speech and eating capabilities. For some patients, plastic reconstructive surgery is indicated. Some advancements have been made in improving the ability to smile with nerve and muscle transfers to the corners of the mouth (NINDS, 2011). Some hospitals offer Facial Reanimation Programs that treat all aspects of facial nerve paralysis and peresis (Boston Childrens Hospital). All surgical care is symptomatic or cosmetic but it is not curative of the underlying syndrome (Palmer et al, 2012). Each treatment plan is designed based on the patient's individual symptoms of the syndrome.
PROGNOSIS
There is no cure for Möbius syndrome due to the fact that it is a development disorder of the cranial nerved 6 and 7. However, individuals generally have a normal life expectancy with normal care and treatment despite the impairments that characterize the disorder. The disorder is overall static, but improvement with age has been observed. In severe cases, respiratory complications may lead to infant death or mortality (Palmer et al. 2012).
Examples of Treatment
Received from www.childrenshospital.org
Common areas of treatment include correction of strabismus (cross-eyed), protection of the cornea, attention to feeding and nutrition, speech-language therapy, early dental intervention, and therapy of the limb abnormalities.
STATIC SLINGS
A piece of a child's tissue is transplanted in order to lift up the drooping skin around the lips and eyelids (the smiling areas). In addition, splints, prostheses, or prophylaxis is suggested for deep venous thrombosis and the musculoskeletal problems.
"SMILE SURGERY"
This is also known as functional muscle transfer which takes muscle from somewhere else in the child's body (usually the thigh) and grafts it onto the corners of the mouth. This restores the ability to smile. Image to the left. It is a two-step procedure that has shown to be very effective in restoring innervation and muscle movement to the areas around the mouth. Patients who go through this procedure report higher levels of self-esteem due to the fact that they can smile (Zuker et. al, 1999).
FEEDING AND VENTILATION
It is recommended to find alternate methods for breastfeeding in these individuals. Some infants require special bottles or feeding tubes (Möbius Syndrome Foundation). In many cases, airways can be obstructed, so there becomes a requirement for tracheobronchial clearing (Palmer et. al, 2012).
TREATMENT OF VISION
Many children with Möbius do not have the ablity to blink and therefore develop dry eye. This is treated with eye drops or in severe cases with tarsorrhaphy, which partially closes the eye. Other associated conditions that are treated are keratitis and conjunctivitis (Palmer et. al, 2012). In addition, the strabismus is usually corrected by surgery, but is usually recommended for later in life because sometimes strabismus goes away with age (Möbius Syndrome Foundation).
TREATMENT OF DENTAL PROBLEMS
The high palate that many Möbius syndrome patients exhibit makes them more prone to crowded, fragile, or misaligned teeth. Many orthodontic devices move the front teeth to a more normal position so that they can close their mouth normally.
SPEECH AND LANGUAGE THERAPY
Children with Möbius syndrome often require speech therapists to help them breath and control their language as well as to help refine their muscle movements. In addition, some children also require psychological care because the inability to communicate is frustrating.
CLUBFOOT
Clubfoot occurs in almost a third of patients with Möbius syndrome. In a lot of cases this can be corrected by orthopedic procedures (Palmer et. al, 2012).
STATIC SLINGS
A piece of a child's tissue is transplanted in order to lift up the drooping skin around the lips and eyelids (the smiling areas). In addition, splints, prostheses, or prophylaxis is suggested for deep venous thrombosis and the musculoskeletal problems.
"SMILE SURGERY"
This is also known as functional muscle transfer which takes muscle from somewhere else in the child's body (usually the thigh) and grafts it onto the corners of the mouth. This restores the ability to smile. Image to the left. It is a two-step procedure that has shown to be very effective in restoring innervation and muscle movement to the areas around the mouth. Patients who go through this procedure report higher levels of self-esteem due to the fact that they can smile (Zuker et. al, 1999).
FEEDING AND VENTILATION
It is recommended to find alternate methods for breastfeeding in these individuals. Some infants require special bottles or feeding tubes (Möbius Syndrome Foundation). In many cases, airways can be obstructed, so there becomes a requirement for tracheobronchial clearing (Palmer et. al, 2012).
TREATMENT OF VISION
Many children with Möbius do not have the ablity to blink and therefore develop dry eye. This is treated with eye drops or in severe cases with tarsorrhaphy, which partially closes the eye. Other associated conditions that are treated are keratitis and conjunctivitis (Palmer et. al, 2012). In addition, the strabismus is usually corrected by surgery, but is usually recommended for later in life because sometimes strabismus goes away with age (Möbius Syndrome Foundation).
TREATMENT OF DENTAL PROBLEMS
The high palate that many Möbius syndrome patients exhibit makes them more prone to crowded, fragile, or misaligned teeth. Many orthodontic devices move the front teeth to a more normal position so that they can close their mouth normally.
SPEECH AND LANGUAGE THERAPY
Children with Möbius syndrome often require speech therapists to help them breath and control their language as well as to help refine their muscle movements. In addition, some children also require psychological care because the inability to communicate is frustrating.
CLUBFOOT
Clubfoot occurs in almost a third of patients with Möbius syndrome. In a lot of cases this can be corrected by orthopedic procedures (Palmer et. al, 2012).
References
- Harvard Medical School (Ed.). (2013). Moebius Syndrome. Retrieved April 22, 2013, from Boston Children's Hospital website: http://www.childrenshospital.org/az/Site1306/mainpageS1306P4.html
- Maccagno, A. (2013, March 16). Mobius Syndrome. Retrieved April 22, 2013, from Mobius Syndrome website: http://flipper.diff.org/app/items/info/5489
- Moebius Syndrome. (2010). Retrieved April 22, 2013, from Moebius Syndrome Global Information Site: http://www.moebiussyndrome.info/research/18-articles/13-mobius-syndrome
- NINDS. (2011, June 23). NINDS Moebius Syndrome Information Page. Retrieved April 22, 2013, from National Institute of Neurological Disorders and Stroke website: http://www.ninds.nih.gov/disorders/mobius/moebius.htm
- Palmer, C. A., MD. (2012). Mobius Syndrome Treatment & Management. In A. Kao, MD (Ed.), Medscape Reference.
- What is Moebius Syndrome? (2007). Retrieved April 21, 2013, from Moebius Syndrome Foundation website http://www.moebiussyndrome.com/index.cfm?objectid=48F93851-BEFB-4468-999417A599ABAB5D
- Zuker, R M (2000) "Facial animation in children with Möbius syndrome after segmental gracilis muscle transplant". Plastic and reconstructive surgery (1963) (0032-1052), 106 (1), p. 1.