Korean J Orthod.  2022 Nov;52(6):451-460. 10.4041/kjod22.012.

Orthodontic treatment in a patient with Moebius syndrome: A case report

• Lee S
• Moon CH

• KMID: 2536338
• DOI: http://doi.org/10.4041/kjod22.012

Abstract

Moebius syndrome (MBS) is a congenital neurologic disorder that causes cranio-facial abnormalities. It involves paralysis of the VI and VII cranial nerves and causes bilateral or unilateral facial paralysis, eye movement disorder, and deformation of the upper and lower limbs. The orofacial dysfunctions include microstomia, micrognathia, hypotonic mimetic and lip muscles, dental enamel hypoplasia, tongue deformity, open bite or deep overbite, maxillary hypoplasia, high arched palate, mandibular hyperplasia or features indicating mandibular hypoplasia. This case report presents a 7-year-old male patient who was diagnosed with MBS at the age 2 years. The patient displayed typical clinical symptoms and was diagnosed with Class II malocclusion with a large overjet/ overbite, tongue deformity and motion limitation, and lip closure incompetency. Treatment was initiated using a removable appliance for left scissor bite correction. After permanent tooth eruption, fixed appliance treatment was performed for correction of the arch width discrepancy and deep overbite. A self-ligation system and wide-width arch form wire were used during the treatment to expand the arch width. After 30 months of phase II treatment, the alignment of the dental arch and stable molar occlusion was achieved. Function and occlusion remained stable with a Class I canine and molar relationship, and a normal overjet/overbite was maintained after 9.4 years of retainer use. In MBS patients, it is important to achieve an accurate early diagnosis, and implement a multidisciplinary treatment approach and long-term retention and follow-up.

Keyword

Dentofacial anomalies; Growth and development; Retention and stability; Moebius syndrome

Figure

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  Figure 1 First phase pre-treatment facial and intraoral photo.

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  Figure 2 First phase pre-treatment. A, Panoramic radiograph. B, Lateral cephalogram. C, Posteroanterior cephalogram.

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  Figure 3 First phase post-treatment facial and intraoral photo.

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  Figure 4 First phase post-treatment. A, Panoramic radiograph, B, Lateral cephalogram, C, Posteroanterior cephalogram.

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  Figure 5 Second phase pre-treatment facial and intraoral photo.

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  Figure 6 Second phase pre-treatment. A, Panoramic radiograph. B, Lateral cephalogram. C, Posteroanterior cephalogram.

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  Figure 7 Second phase treatment progress. A, Initial. B, After 7 months. C, After 18 months.

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  Figure 8 Second phase post-treatment facial and intraoral photo.

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  Figure 9 Second phase post-treatment. A, Panoramic radiograph. B, Lateral cephalogram. C, Posteroanterior cephalogram.

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  Figure 10 Lateral cephalogram superimposition at second phase pre-treatment (black line), after 8 months (red line), post-treatment (green line), and 9.4 years post-retention (blue line).

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  Figure 11 Facial and intraoral photographs, panoramic radiograph, and lateral cephalogram at 9.4 years post-retention.

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