Facial Animation in Mobius Syndrome

Möbius syndrome is a congenital anomaly that compromises the abducens and facial nerves, affecting speech, oral competence and, most important, facial animation. Different procedures have been tried to improve the lack of facial musculature. Microsurgery, especially gracilis muscle transfer, has improved the possibilities for reconstructing facial palsy. Based on the study by Zuker et al., the author presented his experience in segmental gracilis muscle transplant using facial or temporal vessels for revascularization and the motor nerve to the masseter for reinnervation.

Ten patients with Möbius syndrome, 8 unilateral and 2 bilateral, underwent gracilis muscle transfer. To reduce the time of surgery, two teams worked simultaneously, one harvesting the gracilis muscle and the other dissecting receptor vessels and the masseteric nerve. The muscle was anchored into the corner of the mouth and upper lip, providing sufficient tension. In all children, facial animation improved, with good excursion of the oral commissure. In all cases, difficulties with eating, drinking, and drooling improved significantly. Complications were minor despite the complexity and duration of surgery.