Multidisciplinary Care for Moebius Syndrome and Related Disorders: Building a Management Protocol

Abstract

Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.

Keywords: Moebius syndrome; congenital hereditary facial palsy; cranial dysinnervation disorders; multidisciplinary management.

Figure 1

Spectrum of Moebius syndrome features. (A) Scoliosis. (B) Expressionless face, esotropia, epicanthic folds feeding difficulties (tube fed). (C) Bilateral VI palsy, unilateral VII palsy. (D) Rugose hypoplastic tongue. (E) Characteristic expressionless face, epicanthic folds, short upper lip bilateral VI palsy (esotropia) and bilateral VII (facial) palsy. (F) Rugose tongue, bilateral VI and VII palsy following strabismus surgery.

Figure 2

Limb anomalies in Moebius syndrome. (A–D) Photo and radiographs of right and left hands of patient with bilateral symbrachydactyly. (E) Bilateral symbrachydactyly. (F–H) Hypoplastic toes, talipes and syndactyly of feet. (I) Bilateral complicated symbrachydactyly.