Moebius syndrome: Craniofacial clinical manifestations and their association with prenatal exposure to misoprostol

Abstract

Background A growing link between prenatal exposure to misoprostol (PEM) and Moebius syndrome (MS) or sequence has been reported. Our objectives were to describe the craniofacial clinical manifestations associated with MS and to determine the frequency of PEM, comparing cases of exposure and nonexposure. Methods A descriptive, cross‐sectional study of 140 patients with MS. Clinical evaluations, as well as 140 interviews with mothers residing in 39 cities or districts of Colombia, were carried out between April 2008 and May 2018. Additionally, previous clinical history of each case was reviewed. Results The average age of the patients with MS was 8.4 years (29 days to 48 years). All of them presented facial nerve involvement and abducens, 112 (80.8%) with bilateral facial paralysis. 98.5% presented craniofacial disorders, and there were no significant differences between those exposed and not exposed to misoprostol. Forty‐seven percentage of patients (64 cases) presented PEM, in 98.4% of which abortion had been intended. Conclusion PEM could have an influence in the appearance of new cases of MS by increasing the frequency of bleeding during gestation, without increasing the number of associated craniofacial malformations. We present the biggest series on MS and craniofacial findings in the literature, along with a meaningful reference for its understanding. Level of Evidence 3b.

Echoencephalography of Möbius sequence: A congenital cranial dysinnervation disorder with brainstem calcifications

“…44 The leading teratogens causing MBS via vascular disruption during early embryogenesis are the abortifacients methotrexate 45 or mifepristone 46 followed by misoprostol. 37 In 2 of our patients, the fetus was exposed around 6 weeks of gestation to methotrexate followed by misoprostol in a failed attempt at medical abortion.…”

“…Teratogens responsible for MBS exert their influence on the developing fetus around 6 weeks of gestation. 37 Exposure to vasoactive substances leads to various vascular disruption defects responsible for MBS. In early pregnancy, blood supply to the brainstem is rostrocaudal, arising from the two ventral longitudinal neural arteries.…”

“…Teratogens responsible for MBS exert their influence on the developing fetus around 6 weeks of gestation 37 . Exposure to vasoactive substances leads to various vascular disruption defects responsible for MBS.…”

Moebius Syndrome: An Updated Review of Literature

“…In 2007, an international group of researchers at the First Scientific Conference on Möbius Syndrome In Bethesda, Maryland, set the minimum diagnostic criteria (MDC) for Moebius Syndrome as “ a congenital, non-progressive facial weakness, coupled with the inability to abduct one or both eyes ”. 10,37 “Patients with symptoms similar to Moebius Syndrome who do not meet the MDc may be termed as Mobius-like cases”. 10 With a working MDC, it has become easier to sort through the literature and identify cases of Moebius Syndrome, making it easier for researchers to develop newly recognized classification and grading systems.…”