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Porras-García E, Mas-Nieto M, Delgado-García JM, Domínguez-Del-Toro E. Noradrenergic projections regulate the acquisition of classically conditioned eyelid responses in wild-type and are impaired in kreisler mice. Sci Rep 2023; 13:11458. [PMID: 37454229 PMCID: PMC10349844 DOI: 10.1038/s41598-023-38278-4] [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: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
During embryonic development, heterozygous mutant kreisler mice undergo ectopic expression of the Hoxa3 gene in the rostral hindbrain, affecting the opioid and noradrenergic systems. In this model, we have investigated behavioral and cognitive processes in their adulthood. We confirmed that pontine and locus coeruleus neuronal projections are impaired, by using startle and pain tests and by analyzing immunohistochemical localization of tyrosine hydroxylase. Our results showed that, even if kreisler mice are able to generate eyelid reflex responses, there are differences with wild-types in the first component of the response (R1), modulated by the noradrenergic system. The acquisition of conditioned motor responses is impaired in kreisler mice when using the trace but not the delay paradigm, suggesting a functional impairment in the hippocampus, subsequently confirmed by reduced quantification of alpha2a receptor mRNA expression in this area but not in the cerebellum. Moreover, we demonstrate the involvement of adrenergic projection in eyelid classical conditioning, as clonidine prevents the appearance of eyelid conditioned responses in wild-type mice. In addition, hippocampal motor learning ability was restored in kreisler mice by administration of adrenergic antagonist drugs, and a synergistic effect was observed following simultaneous administration of idazoxan and naloxone.
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Affiliation(s)
- Elena Porras-García
- Division of Neurosciences, University Pablo de Olavide, Ctra. de Utrera, Km. 1, 41013, Sevilla, Spain
| | - Magdalena Mas-Nieto
- Division of Neurosciences, University Pablo de Olavide, Ctra. de Utrera, Km. 1, 41013, Sevilla, Spain
| | - José María Delgado-García
- Division of Neurosciences, University Pablo de Olavide, Ctra. de Utrera, Km. 1, 41013, Sevilla, Spain
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Oda A, Oue K, Oda Y, Taguchi S, Takahashi T, Mukai A, Doi M, Shimizu Y, Irifune M, Yoshida M. Difficult intubation and postoperative aspiration pneumonia associated with Moebius syndrome: a case report. BMC Anesthesiol 2022; 22:316. [PMID: 36221060 PMCID: PMC9552434 DOI: 10.1186/s12871-022-01859-3] [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: 06/02/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Moebius syndrome is a rare congenital disorder characterized by non-progressive palsy of the abducens (VI) and facial (VII) cranial nerves. Its common features include dysfunctions associated with other cranial nerves, orofacial abnormalities, skeletal muscle hypotonia, and other systemic disorders of differing severities. There are several concerns in the perioperative management of patients with Moebius syndrome. Case presentation We present a report on the management of general anesthesia of a 14-year-old male patient with Moebius syndrome who was scheduled for mandibular cystectomy. The patient was diagnosed with Moebius syndrome at the age of 7 years based on his clinical manifestations of nerve palsy since birth and cranial nerve palsy of the trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and sublingual nerves (XII). The patient’s oral morphological abnormalities made intubation difficult. He also experienced dysphagia and aspiration pneumonia on a daily basis. Oral secretions were frequently suctioned postoperatively. However, after discharge, the patient developed aspiration pneumonia and was readmitted to the hospital. Conclusions The main problem arising when administering general anesthesia to patients with this syndrome is difficult airway management. The oral abnormalities in these patients, such as small jaw and extreme dental stenosis, make mask ventilation and intubation difficult. Furthermore, this syndrome often involves respiratory impairment and dysphagia due to cerebral nerve palsy, so there is a high risk of postoperative respiratory complications. Since multiple organs are affected in patients with Moebius syndrome, appropriate perioperative management strategies must be prepared for these patients.
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Affiliation(s)
- Aya Oda
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Kana Oue
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Yuki Oda
- Department of Special Care Dentistry, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shima Taguchi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Tamayo Takahashi
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Akari Mukai
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuru Doi
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Irifune
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuhiro Yoshida
- Department of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
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Bell C, Nevitt S, McKay VH, Fattah AY. Will the real Moebius syndrome please stand up? A systematic review of the literature and statistical cluster analysis of clinical features. Am J Med Genet A 2018; 179:257-265. [PMID: 30556292 DOI: 10.1002/ajmg.a.60683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023]
Abstract
Moebius syndrome is a highly variable syndrome with abducens and facial nerve palsy as core features. Strict diagnostic criteria do not exist and the inconsistency of the associated features makes determination difficult. To determine what features are associated with Moebius syndrome we performed a systematic literature review resulting in a composite case series of 449 individuals labeled with Moebius syndrome. We applied minimum criteria (facial and abducens palsy) to determine the prevalence of associated clinical features in this series. Additionally, we performed statistical cluster analysis to determine which features tended to occur together. Our study comprises the largest series of patients with Moebius syndrome and the first to apply statistical methodology to elucidate clinical relationships. We present evidence for two groups within the Moebius diagnosis. Type 1: exhibiting micrognathia, limb anomalies and feeding/swallowing difficulty that tend to occur together. Type 2: phenotypically diverse but more associated with radiologically detectable neurologic abnormalities and developmental delay.
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Affiliation(s)
- Chris Bell
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Victoria H McKay
- Department of Clinical Genetics, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Adel Y Fattah
- Facial Nerve Programme, Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children's Foundation Trust, Liverpool, United Kingdom
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An exome sequencing study of Moebius syndrome including atypical cases reveals an individual with CFEOM3A and a TUBB3 mutation. Cold Spring Harb Mol Case Stud 2017; 3:a000984. [PMID: 28299356 PMCID: PMC5334472 DOI: 10.1101/mcs.a000984] [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] [Indexed: 12/15/2022] Open
Abstract
Moebius syndrome is characterized by congenital unilateral or bilateral facial and abducens nerve palsies (sixth and seventh cranial nerves) causing facial weakness, feeding difficulties, and restricted ocular movements. Abnormalities of the chest wall such as Poland anomaly and variable limb defects are frequently associated with this syndrome. Most cases are isolated; however, rare families with autosomal dominant transmission with incomplete penetrance and variable expressivity have been described. The genetic basis of this condition remains unknown. In a cohort study of nine individuals suspected to have Moebius syndrome (six typical, three atypical), we performed whole-exome sequencing to try to identify a commonly mutated gene. Although no such gene was identified and we did not find mutations in PLXND1 and REV3L, we found a de novo heterozygous mutation, p.E410K, in the gene encoding tubulin beta 3 class III (TUBB3), in an individual with atypical Moebius syndrome. This individual was diagnosed with near-complete ophthalmoplegia, agenesis of the corpus callosum, and absence of the septum pellucidum. No substantial limb abnormalities were noted. Mutations in TUBB3 have been associated with complex cortical dysplasia and other brain malformations and congenital fibrosis of extraocular muscles type 3A (CFEOM3A). Our report highlights the overlap of genetic etiology and clinical differences between CFEOM and Moebius syndrome and describes our approach to identifying candidate genes for typical and atypical Moebius syndrome.
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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: 5] [Impact Index Per Article: 0.7] [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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Shawky RM, Gamal R, Abdelsattar Mohammad S. Moebius syndrome with macular hyperpigmentation, skeletal anomalies, and hypoplasia of pectoralis major muscle in an Egyptian child. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2015. [DOI: 10.1016/j.ejmhg.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chou IC, Lin WD, Wang CH, Chang YT, Chin ZN, Tsai CH, Tsai FJ. Möbius syndrome in a male with XX/XY mosaicism. Biomedicine (Taipei) 2013. [DOI: 10.1016/j.biomed.2013.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yetiser S. Non-traumatic congenital facial nerve paralysis; electroneurophysiologic evaluation of four cases. Int J Pediatr Otorhinolaryngol 2005; 69:1419-27. [PMID: 15927271 DOI: 10.1016/j.ijporl.2005.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Revised: 02/10/2005] [Accepted: 03/25/2005] [Indexed: 12/25/2022]
Abstract
Non-traumatic congenital facial paralysis is frequently due to intrauterine hypoplasia of the facial nerve and usually appears as a component of a syndrome. The experience about this problem is limited due to its rare occurrence and sometimes differential diagnosis of congenital facial paralysis of developmental origin from an acquired one in children and infants needs much effort. Controversy remains regarding the site of the lesion. Total facial paralysis is uncommon and inherited transmission has been reported on some occasion. Four children with congenital facial paralysis, whose family history is noncontributory, are presented in this report and the related literature is reviewed.
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Affiliation(s)
- Sertac Yetiser
- Gulhane Medical School, Department of ORL; HNS, Etlik, 06018 Ankara, Turkey.
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Verzijl HTFM, Padberg GW, Zwarts MJ. The spectrum of Möbius syndrome: an electrophysiological study. Brain 2005; 128:1728-36. [PMID: 15829555 DOI: 10.1093/brain/awh502] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We studied the nature and extent of facial muscle innervation and the involvement of the motor and sensory long tracts in Möbius syndrome, in order to shed light on the pathophysiological mechanism of the syndrome. Standardized blink reflexes, direct responses of the facial nerves to the orbicularis oculi muscles and concentric needle electrode electromyography in orbicularis oculi and/or oris muscles were measured in 11 patients with Möbius syndrome, of whom six participated in MRI studies, all showing absent facial nerves. We performed motor- and somatosensory-evoked potentials in seven Möbius patients. We demonstrated three distinct patterns of abnormalities suggesting different sites of the primary lesion in different patients. (i) Presence of normal blink reflexes and facial compound motor action potentials, normal habituation tests, a reduced recruitment in the facial muscles and an aberrant 'blink reflex-like' response of the orbicularis oculi muscle upon stimulation of the facial nerve region, which suggests a supranuclear origin of the defect. (ii) Absent blink reflexes, absent direct responses of the facial nerves and absent motor activity on needle electromyography, indicating a defect at the facial nuclear level. However, the nuclear defect might mask an additional supranuclear defect, which cannot, therefore, be excluded in these patients. (iii) A disperse pattern of facial compound action potentials combined with long latencies that were recorded with concentric needle electrodes, indicating involvement of motor axons in the facial nerve, possibly secondary to nuclear involvement. An additional supranuclear defect cannot be excluded in these cases. All evoked potentials studied were normal. The electrophysiological findings of the facial muscles show a spectrum of disturbances varying in degree of severity and diverse in the extent of structures involved, in 11 Möbius patients. At one end of the spectrum are patients with completely immobile faces in whom electrophysiological testing shows no signs of involvement of the facial nuclei, nerves or muscles, suggestive of a dysfunction at the supranuclear level. At the other extreme of the spectrum are patients with complete absence of responses upon facial nerve stimulation and absence of motor unit activity. This is at least indicative of a defect at the facial nuclear level. While a supranuclear defect is compatible with the concept that Möbius syndrome is a developmental disorder of the lower brainstem, intact facial nuclei as part of the syndrome has not been suggested before. The findings corroborate the concept of the Möbius syndrome being a complex regional developmental disorder of the brainstem.
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Affiliation(s)
- Harriëtte T F M Verzijl
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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11
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Criado GR, Aytés AP. Möbius sequence, hypogenitalism, cerebral, and skeletal malformations in two brothers. AMERICAN JOURNAL OF MEDICAL GENETICS 1999; 86:492-6. [PMID: 10508994 DOI: 10.1002/(sici)1096-8628(19991029)86:5<492::aid-ajmg17>3.0.co;2-e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Two brothers born to a healthy, consanguineous Spanish couple have a syndrome of Möbius sequence with involvement of cranial nerves V, VI, VII, IX, and XII, central nervous system malformations; characteristic face with creased earlobes, short philthrum, and a short, arched upper lip, skeletal anomalies with short sternum and delayed bone maturation, hypogenitalism, and profound mental retardation. We suggest that this is a new multiple congenital anomalies condition and mental retardation (MCA/MR) syndrome with autosomic recessive inheritance.
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Affiliation(s)
- G R Criado
- Unidad de Dismorfología, Hospital Infantil Universitario Virgen del Rocío, Sevilla, Spain.
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12
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Abstract
The etiology of strabismus has long been observed to have a genetic component. Recent advances in genetic methodology may provide insight into the genetic basis for several types of inherited strabismus, including those associated with genetic multisystem disorders such as Moebius syndrome, Prader-Willi syndrome, craniofacial dysostoses, and mitochondrial myopathies. Inheritance of primary forms of strabismus, such as congenital ocular fibrosis, Brown syndrome and Duane syndrome, has been reported, but less is known of the defective genetic sites. The genetic basis for isolated strabismus that clusters in families, such as infantile esotropia syndrome, is also not yet known, but new techniques of molecular biology may now permit linkage detection in these families. By identifying affected families, clinicians will take part in unraveling the genetic basis of hereditary strabismus syndromes.
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Affiliation(s)
- T O Paul
- Smith-Kettlewell Eye Research Institute, San Francisco, CA 94115
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Rojas-Martínez A, García-Cruz D, Rodríguez García A, Sánchez-Corona J, Rivas F. Poland-Moebius syndrome in a boy and Poland syndrome in his mother. Clin Genet 1991; 40:225-8. [PMID: 1773538 DOI: 10.1111/j.1399-0004.1991.tb03081.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 4 4/12-year-old boy with the Poland-Moebius syndrome, whose mother had the POland syndrome, is presented. This is the first report of the occurrence of both syndromes in the same family, suggesting that they are expressions of the same autosomal dominant gene.
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Affiliation(s)
- A Rojas-Martínez
- División de Genética, Hospital de Pediatría, Guadalajara, Jalisco, México
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Brackett LE, Demers LM, Mamourian AC, Ellenberger C, Santen RJ. Moebius syndrome in association with hypogonadotropic hypogonadism. J Endocrinol Invest 1991; 14:599-607. [PMID: 1940066 DOI: 10.1007/bf03346879] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The association between hypogonadotropic hypogonadism and multiple CNS lesions in a variety of disorders suggests a possible causative link between these clinical findings. Neural afferent input into the hypothalamus from higher CNS centers modulates GnRH secretion and derangements of these neural pathways could potentially result in diminished gonadotropin secretion and hypogonadism. This report describes a patient with multiple CNS defects secondary to Moebius syndrome and hypogonadotropic hypogonadism whose clinical features support the hypothesis that his CNS and endocrine defects may be causally associated. Comprehensive clinical evaluation in this patient revealed severe mental retardation; cranial nerve palsies; motor, reflex, and gait disturbances; and sexual infantilism secondary to hypogonadotropic hypogonadism. An MRI of the brain revealed atrophy or hypoplasia of the third cranial nerve and the olfactory gyri. Numerous syndromes including the Moebius syndrome are now described in which hypogonadotropic hypogonadism and CNS defects are associated. Detailed neuroanatomic and embryologic studies have demonstrated the important functional interrelationships between higher central nervous system centers and the hypothalamus. Taken together, these findings provide support for the causative association of multiple CNS defects and hypogonadotropic hypogonadism.
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Affiliation(s)
- L E Brackett
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey 17033
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Lipson AH, Webster WS, Brown-Woodman PD, Osborn RA. Moebius syndrome: animal model--human correlations and evidence for a brainstem vascular etiology. TERATOLOGY 1989; 40:339-50. [PMID: 2683181 DOI: 10.1002/tera.1420400406] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The Moebius syndrome consists of congenital seventh nerve palsy associated with other cranial nerve palsies, most often of the sixth, and/or musculoskeletal abnormalities. A retrospective study of the events of pregnancy in 15 cases was undertaken, after a rat animal model showed that abdominal trauma, uterine vessel clamping and handling and hyperthermia caused bilateral brainstem lesions in fetal rats. Eight of the 15 cases surveyed included a possible associated event during pregnancy; hyperthermia, previous uterine surgery, electric shock, failed abortion, prolonged rupture of the membranes, or alcohol abuse. These events can be correlated with animal studies that involve acute uteroplacental vascular insufficiency produced by a variety of methods. The cause of most cases of Moebius syndrome is probably a transient ischemic/hypoxic insult to the fetus.
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Affiliation(s)
- A H Lipson
- Genetics and Dysmorphology Unit, Children's Hospital, Camperdown, New South Wales, Australia
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Abstract
There exists a spectrum of syndromes characterized by cranial nerve palsies, limb anomalies, and craniofacial malformations. Criteria based on type and severity of limb anomaly or presence or absence of cranial nerve palsy may alter the syndrome nomenclature due to a selection bias but do not appear to benefit syndrome delineation to any extent. Patients with seventh nerve palsy and abduction weakness are usually diagnosed as having Möbius syndrome by ophthalmologists. The observed ocular motility findings range from primarily abduction deficiencies to patients who have a Duane or gaze palsy pattern of horizontal movements. Some cases previously described as "sixth nerve and partial third" may better fall into one of the latter groups, since an isolated adduction deficit as a manifestation of third nerve involvement is rare. The presence of clinical appearance of Duane syndrome in these Möbius-type patients raises the possibility of abnormal innervation of the lateral rectus as an explanation of some patterns of motility observed.
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Affiliation(s)
- M T Miller
- University of Illinois, Department of Ophthalmology, Chicago, 60612
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