Moebius Syndrome Surgery Options

At The Facial Paralysis Institute, we know how difficult a diagnosis of Moebius syndrome can be for you or your child. The most common facial reanimation procedures for treating Moebius syndrome with surgery include Temporalis Tendon Transfer, Bilateral Gracilis Muscle Transfer to Masseter Nerve, Bilateral Selective Neurolysis, and Eyelid Reconstruction. Our team of world-renowned facial paralysis surgeons are here to help patients with Moebius syndrome regain their ability to make facial expressions and smile, as well as correct eyelid functions and appearance.

Knowing that every patient is unique, we will develop a customized Moebius syndrome treatment plan to give our patients the best results possible. As such, all Moebius syndrome patients will undergo a very thorough consultation with Dr. Babak Azizzadeh so he can evaluate the patient and determine the best treatment plan. Dr. Azizzadeh offers Skype consultations for patients who do not live in Southern California, so that they are still able to consult with the leading facial paralysis expert regardless of where they live.

If you are or your child are suffering from Moebius syndrome, please call the Facial Paralysis Institute today at (310) 657-2203 to schedule your consultation with Dr. Azizzadeh.

Examining the genetics of congenital facial paralysis — A closer look at Moebius syndrome

Download Dr. Azizzadeh’s article on Moebius Syndrome.

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What Is Moebius Syndrome?

Moebius syndrome refers to a rare neurological condition that hampers a person’s ability to make facial expressions and control eye movement. It is commonly associated with facial paralysis or weakness.
People born with Moebius syndrome often have a small chin, small mouth and short tongue. They may also have an abnormal opening at the roof of the mouth. These issues may cause speech problems, along with missing or misaligned teeth.

Additionally, Moebius syndrome affects a person’s ability to make back-and-forth eye movements. It may make it difficult for a person to completely close his or her eyes when blinking or sleeping as well. This increases a Moebius syndrome patient’s risk of eye irritation and dryness.

How Is Moebius Syndrome Diagnosed?

Moebius syndrome is generally diagnosed based on two clinical criteria: the appearance of non-progressive congenital facial weakness and an inability to move one or both eyes away from the nose. Also, an individual dealing with Moebius syndrome may display one or more of the following symptoms:

• Misalignment of the eyes
• Hearing loss
• Club foot
• Limb abnormalities
• Congenital heart disease
• Developmental delay
• Autism

Research shows Moebius syndrome occurs in anywhere from two to 20 cases per million births. Moebius syndrome also affects individuals of all ethnicities, and it has no gender bias.

What Causes Moebius Syndrome?

There is no surefire cause of Moebius syndrome. However, research indicates Moebius syndrome may occur due to a combination of environmental and genetic factors. Some researchers have also discovered specific genes may be related to Moebius syndrome. Various medications taken during pregnancy and drug abuse may also cause Moebius syndrome.

Is Moebius Syndrome Genetic?

Most Moebius syndrome cases are sporadic, and as such, occur in people with no family history of the disorder. Researchers continue to study Moebius syndrome to determine if genetics are the primary cause for the condition. To date, researchers have found changes in certain genes may cause Moebius syndrome. But there is still no proof that Moebius syndrome is a genetic condition.

Candidates for Moebius Syndrome Treatment

Moebius syndrome treatment is usually performed on children before they enter school. Additionally, since each Moebius syndrome patient has a unique presentation of the condition, and treatment is specifically tailored to the patient.

Dr. Azizzadeh allocates significant time and resources to learn about a Moebius syndrome patient and his or her facial paralysis symptoms. He then develops a personalized treatment plan for a patient. By doing so, Dr. Azizzadeh ensures a patient can achieve the best-possible treatment results.

Moebius Syndrome Treatments

Many Moebius syndrome patients are unable to smile or frown or make lateral eye movements. As a result, Moebius syndrome treatments are designed to help patients improve facial reanimation.

For dual facial paralysis, The Facial Paralysis Institute uses microsurgical trigeminal-gracilis muscle transfer. This procedure involves transfer of the gracilis muscle (from the inner thigh) to the face and attachment to the trigeminal nerve, which controls the muscles for chewing. The gracilis muscle and nerve transfer allows children to control the movement of the face voluntarily. For this treatment option, each side of the face must be treated in separate stages. Typically, the first operation is performed when the child has turned 6. The second stage is then performed at age 7.

Temporalis Tendon Transfer for Moebius Syndrome

The temporalis muscle is one of the muscles that we use for chewing and is one of the strongest and most dynamic muscles in our body. The trigeminal nerve (cranial nerve 5) is responsible for it’s activity. Since this nerve is generally unaffected by Moebius Syndrome, we can use this muscle to achieve facial reanimation. During the procedure, Dr. Azizzadeh makes a tiny incision around the laugh lines of the mouth to locate the temporalis tendon, and then he rotates the tendon of the temporalis muscle over and attaches it to the corner of the mouth. When the patient bites down, the face naturally moves. This temporalis transfer procedure has been very successful in rehabilitating dynamic facial movement and creating facial symmetry for patients with Moebius Syndrome.

Bilateral Gracilis Muscle Transfer to Masseter Nerve for Moebius Syndrome

For the majority of patients with Moebius Syndrome, their native facial muscles are not functional. Therefore, the gracilis muscle (located in the inner thigh) needs to be used to help generate spontaneous facial movement. The gracilis muscle is unique in that it can be harvested along with its nerve, artery and vein and transferred to the face. Using microsurgical techniques, Dr. Azizzadeh will take a small portion of gracilis muscle from each inner thigh, transfer the muscles to both sides of the patient’s face, and attach the gracilis muscles to the masseter nerves. The masseter nerve (originating from the 5th cranial nerve) is responsible for activating the muscles used to chew, and therefore when connected to the gracilis muscles, supports dynamic facial reanimation. Over the next 6 – 9 months, the muscles activate and the patient achieves a symmetrical smile and strong facial movement capabilities. The strength and control of the reconstructed smile continues to improve over the next few years.

Bilateral Selective Neurolysis for Moebius Syndrome

The most cutting edge advancement in facial paralysis surgery, bilateral selective neurolysis provides spontaneous reanimation of the face for the appropriate Moebius Syndrome patient. Pioneered by Dr. Azizzadeh, selective neurolysis is an intricate operation, but the downtime and risks involved for the patient are minimal. The procedure involves releasing the platysma muscles (which pull the corners of the mouth down, hence preventing upward smile motion) and selectively decreasing the activity of the nerves that counter the smile mechanism to help get an upward trajectory of the mouth. These procedures allow spontaneous reanimation of the face. Selective neurolysis is also a phenomenal treatment for patients with unilateral or bilateral Bell’s palsy.

Eyelid Reconstruction for Moebius Syndrome

Individuals with Moebius Syndrome may suffer from strabismus (crossed eyes) or eyelid closure issues. Together, Dr. Azizzadeh and Dr. Massry can perform a number of surgeries to reconstruct the eyes and eyelids, including but not limited to:

The goal of eyelid reconstruction procedures is to improve vision and tighten eyelid muscles to allow for easier closer while still maintaining a natural and symmetrical appearance.

For more information about Moebius Syndrome, please visit The Moebius Syndrome Foundation’s website.

Why Choose Dr. Azizzadeh For Your Moebius Syndrome Surgery?

Babak Azizzadeh, MD, FACS, is a world-renowned Facial Plastic & Reconstructive Surgeon who is deeply committed to the treatment of individuals with facial paralysis and Moebius Syndrome. He is double board certified by the American Board of Facial Plastic & Reconstructive Surgery and the American Board of Otolaryngology-Head & Neck Surgery. Additionally, Dr. Azizzadeh completed a prestigious fellowship focusing on facial nerve anatomy and reconstruction at Harvard Medical School that provided him with an unparalleled knowledge of facial aesthetics and underlying facial anatomy. As a pioneer in his field, Dr. Azizzadeh is the author of the preeminent textbook “The Facial Nerve” and has contributed to hundreds of peer-reviewed articles. Because of his prestigious training and unique knowledge of facial paralysis, Dr. Azizzadeh has been asked to host the 13th Annual International Facial Nerve Symposium in August 2017.

As the primary surgeon involved in Mary Jo Buttafuoco’s miraculous facial reanimation surgery following a devastating gunshot wound to the face, Dr. Azizzadeh was a featured guest on The Oprah Winfrey Show. He is the only facial nerve specialist to be featured on the show. Additionally, Dr. Azizzadeh has been asked to contribute to The New York Times, People magazine, Discovery Health, and The Doctors television show, among others, for his distinct expertise in the field.

In addition to his surgical practice, Dr. Azizzadeh is extremely active in several different humanitarian causes, including the Global Smile Foundation and the Facial Paralysis & Bell’s Palsy Foundation, which he founded in 2009.