Page 110 - FINAL COMPENDIUM 2020-2021 27.2.2022

AN ANXIOUS BOY WITH MOEBIUS SYNDROME: A CASE REPORT

Yap LYI, Mohd Ariffin S

Introduction: Moebius syndrome (MS) is a rare, congenital, non-progressive neurological
condition characterised by weakness or paralysis of multiple cranial nerves. The sixth
(Abducens) and seventh (Facial) cranial nerves are most frequently affected resulting in
classical clinical presentations of (1) “mask-like” facies due to lack of facial expression,
usually bilaterally and (2) limited abduction of one or both eyes in affected individuals.
MS affects both genders equally and occurs in all ethnicities. The exact incidence of MS is
unknown. The aetiology of MS remains unspecified but may be due to genetic and/or
environmental factors. Intellectual disabilities have been reported in approximately 10-
15% of cases. Common orofacial manifestations include microstomia, micrognathia, cleft
palate or high vault palate, deep fissured tongue, bifid uvula, hypodontia, hypoplastic
teeth, hypoplastic upper lip, incompetent lips and dental caries. These manifestations
could lead to various dental issues requiring multidisciplinary management. This case
report presents the long-term dental management of an anxious boy with underlying MS.
Case report: The patient was initially referred to the Department of Paediatric Dentistry
in 2013 when he was 2 years 5 months old for management of gingival bleeding. He was
diagnosed with severe early childhood caries and generalised gingivitis and undergone his
first comprehensive dental treatment (CDT) under General anaesthesia (GA).
Subsequently, he was on our periodic dental reviews. Unfortunately, due to persistent
poor parental motivation, he was consistently categorised as high caries risk with poor
oral hygiene. In addition to his short attention span and anxious behaviour, chair-side
dental management was not a viable long-term treatment option. Therefore, he
underwent two more CDTs under GAs in 2015 and 2020. His MS features include mask-
like face and unable to abduct eyes, micrognathia, incompetence lips and hypoplastic
upper lip. Intra-oral examination revealed poor oral hygiene, dental caries, fissured
tongue and Class II division I malocclusion with an overjet of 8mm and deep bite. For his
long-term dental plan, he may benefit from Orthodontic treatment. However, he is
currently not a suitable candidate due to his poor oral hygiene and anxious behaviour.
Thus, he continues to be on our periodic preventive follow up. Conclusion: As with all
Paediatric dental patients, basic preventive measures and periodic follow ups are
paramount in MS patients not only to maintain good oral health and quality of life but
also to improve patient’s attitude towards dental treatment and subsequently future
multidisciplinary dental treatment.

Keywords: Moebius syndrome, Dental management, Orofacial findings

Virtual poster presentation at the 10 Pahang Research Day 2021 on 22 October 2021.
th
Dr Ivy Yap Lye Yee
Dr Shina Mohd Ariffin
Department of Paediatric Dentistry
Hospital Sultan Haji Ahmad Shah
Temerloh, Pahang

86