A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies.

Objective: To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method: A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.

Prosthodontic Management of a Patient with Moebius Syndrome: A Clinical Report.

Moebius/MÓ§bius Syndrome (MS) is an extremely rare congenital disorder characterized by uni- or bilateral palsy of the abducens (VI) and the facial (VII) nerves, causing facial paralysis. Dysfunction of cranial nerves III through XII is common, most often the glossopharyngeal (IX) and hypoglossus (XII). Afflicted individuals seeking prosthodontic care, particularly removable prosthetics, present multiple challenges related to inherent facial and tongue muscle weakness and microstomia. Other extraoral anomalies may include congenital multiple arthrogryposis and malformations of the upper and lower limbs. This clinical report describes the rehabilitation of a patient with Moebius Syndrome using a maxillary 2-implant retained overdenture and mandibular partial removable denture prosthesis.

A proposal for new neurorehabilitative intervention on Moebius Syndrome patients after 'smile surgery'. Proof of concept based on mirror neuron system properties and hand-mouth synergistic activity.

Studies of the last twenty years on the motor and premotor cortices of primates demonstrated that the motor system is involved in the control and initiation of movements, and in higher cognitive processes, such as action understanding, imitation, and empathy. Mirror neurons are only one example of such theoretical shift. Their properties demonstrate that motor and sensory processing are coupled in the brain. Such knowledge has been also central for designing new neurorehabilitative therapies for patients suffering from brain injuries and consequent motor deficits. Moebius Syndrome patients, for example, are incapable of moving their facial muscles, which are fundamental for affective communication. These patients face an important challenge after having undergone a corrective surgery: reanimating the transplanted muscles to achieve a voluntarily control of smiling. We propose two new complementary rehabilitative approaches on MBS patients based on observation/imitation therapy (Facial Imitation Therapy, FIT) and on hand-mouth motor synergies (Synergistic Activity Therapy, SAT). Preliminary results show that our intervention protocol is a promising approach for neurorehabilitation of patients with facial palsy.

"Rare place where I feel normal": Perceptions of a social support conference among parents of and people with Moebius syndrome.

BACKGROUND: Moebius syndrome is a rare congenital disorder resulting in impaired facial and eye movement. People with rare diseases like Moebius syndrome experience stigma and a lack of specialized information. Support conferences may provide important forms of social support for people with rare disorders. AIMS: To examine reasons for attending, benefits, and limitations of support conferences. METHODS AND PROCEDURES: 50 adults with Moebius syndrome and 57 parents of people with Moebius syndrome completed open-ended items in an online study. OUTCOMES AND RESULTS: Mixed- methods content analysis revealed that companionship and informational support were most frequently mentioned as reasons for and benefits of attending. Finances were the most frequently mentioned reason for not attending. Parents were more likely than people with Moebius to describe instrumental support as a conference benefit. When describing conference limitations, parents were significantly more concerned by lack of information relevance, while people with Moebius noted more often that conference attributes were not relevant to their age. CONCLUSIONS AND IMPLICATIONS: Being surrounded by others who share one's condition offers a unique opportunity for destigmatizing companionship support, which normalizes, reduces isolation, and promotes solidarity. Ways to increase facilitators and decrease barriers to accessing support for rare disorders should be investigated.

Brain plasticity in Möbius syndrome after unilateral muscle transfer: case report and review of the literature.

BACKGROUND: Möbius syndrome is mainly characterized by bilateral facial palsy. Facial reanimation of these children is achieved by microsurgical techniques, namely free-gracilis muscle innervated by the masseteric nerve. Notorious commissure excursion and speech improvement are reported with such procedure. Several studies have demonstrated the presence of cortical reorganization after injury and repair of different segments of the body. Intensive training of a behaviorally relevant task is key in this process. CASE REPORT: A 4-year-old patient with complete bilateral facial palsy secondary to Möbius syndrome was operated with left hemiface free-gracilis muscle transplant innervated by the masseteric nerve and submitted for postoperative physiotherapy. Eight months later, bilateral movement was noted. CONCLUSIONS: Brain plasticity is likely to play an important role in smile restoration in patients with bilateral facial palsy. Intensive physiotherapy and psychosocial relevance of facial expression might be key in such phenomenon.

Oral implant rehabilitation in a patient with Moebius syndrome

Introduction: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to deficient lip sealing, micrognathia, microstomia, bifid uvula, gothic and fissured palate, fissured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. Clinical case: We report the case of a woman with Moebius syndrome and total edentulism. Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. Discussion: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants (AU)

Oral implant rehabilitation in a patient with Moebius syndrome.

INTRODUCTION: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to deficient lip sealing, micrognathia, microstomia, bifid uvula, gothic and fissured palate, fissured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. CLINICAL CASE: We report the case of a woman with Moebius syndrome and total edentulism . Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. DISCUSSION: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants.