Dental management of a patient with Moebius syndrome: A case report

Abstract

BACKGROUND Moebius syndrome (MBS) is a nonprogressive and rare congenital neuromuscular disorder involving the facial nerve and abductor nerve; it mainly manifests as facial paralysis and eye strabismus paralytic symptoms. Tissues in the oral cavity are also compromised, characterized by microstomia, micrognathia, tongue malformation, cleft lip, high arched palate or cleft palate, bifid uvula, and dental malocclusion. Therefore, dentistry plays a fundamental and crucial role in caring for these individuals. However, there is limited available data on MBS treatment, particularly regarding dental management. CASE SUMMARY This case report presents dental treatment of a 21-year-old man with MBS and discusses crucial interactions among oral complications of MBS. In this case, the patient was clinically characterized by congenital neuromuscular disorder, occlusal disorders, and tooth and gum problems. It is noteworthy that the patient presented early eruption of deciduous teeth 2 mo after birth, which has not been reported in other MBS cases and suggests a potentially new clinical manifestation of this syndrome. It is important to note that MBS cannot be cured, and oral manifestations of this syndrome can be managed by a multidisciplinary health care team that helps the patient maintain oral hygiene and dental health. After a series of oral treatments, no obvious poor oral hygiene, swollen gums, or abnormal imaging results were observed after 2 years of follow-up. CONCLUSION This case addressed the oral clinical manifestations of MBS and difficulties experienced during dental management, and suggested early tooth eruption as a potentially new clinical manifestation of this syndrome. Knowledge of the loop-mediated association among oral complications of this syndrome is essential to perfecting treatments.

The challenging management of Moebius syndrome using orthodontic camouflage: A case report

“…This is due to a tedious impression‐making process, technical difficulty in fitting fixed appliances, and compliance issues. Recording alginate impressions may be difficult as many of them have microstomia, inelastic stoma, dry lip mucosa and angular cheilitis 8,29 …”

“…The poor oral hygiene seen in MS has been attributed to dysfunction/hypomobility of masticatory and tongue muscles (compromised mastication), 7,8 impaired deglutition causing prolonged retention of semi-solid carbohydrate rich foods in the mouth. 23 To motivate this patient, verbal oral hygiene instructions for toothbrushing (modified Bass technique, at least three times daily) were reinforced at every appointment.…”

“…It's clinically expressed as facial palsy combined with impairment of ocular abduction, cleft palate, tongue abnormalities, micrognathia, ear deformities, and concurrent limb malformations (e.g., ectrodactyly, syndactyly, arthrogryposis) 7 . Patients also present with feeding and breathing difficulties immediately after birth, related to micrognathia and glossoptosis 8,9 . As patients age, they lack facial expression, develop severe speech problems, and, sometimes mental retardation, leading to behavioral problems and difficulty in social adaptation 6 …”

“…7 Patients also present with feeding and breathing difficulties immediately after birth, related to micrognathia and glossoptosis. 8,9 As patients age, they lack facial expression, develop severe speech problems, and, sometimes mental retardation, leading to behavioral problems and difficulty in social adaptation. 6 Etio-pathogenesis of MS remains inconclusive.…”

Moebius Syndrome: An Updated Review of Literature

“…16 Other orthodontic manifestations may include microstomia, tongue malformation, high-arched palate, cleft lip or cleft palate, bifid uvula, and dental malocclusion. 17 Moebius Syndrome is also markedly characterized by an overall global delay at one year and impaired speech, motor, and emotional maturity at two years, normalizing when the child turns three. Even so, weak cognitive function, poor hand-eye coordination, and an average IQ may persist until age five.…”