title: Moebius sequence -a multidisciplinary clinical approach.
abstract: Moebius Sequence (MS) is a rare disorder defined by bilateral congenital paralysis of the abducens and facial nerves in combination with various odontological, craniofacial, ophthalmological and orthopaedic conditions. The aetiology is still unknown; but both genetic (de novo mutations) and vascular events in utero are reported. The purpose of present study was through a multidisciplinary clinical approach to examine children diagnosed with Moebius-like symptoms. Ten children underwent odontological, ophthalmological, obstetric, paediatric, orthopaedic, genetic, radiological and photographical evaluation. Five patients maintained the diagnosis of MS according to the diagnostic criteria.
  
  
  
  All five patients had bilateral facial and abducens paralysis confirmed by ophthalmological examination. Three of five had normal brain MR imaging. Two had missing facial nerves and one had missing abducens nerves. The Strengths and Difficulties Questionnaire (SDQ) showed normal scores in three of five patients. Interestingly, two of five children were born to mothers with uterine abnormalities (unicornuate/bicornuate uterus). In the odontological examination three of five showed enamel hypomineralisation. All five had abnormal orofacial motor function and maxillary prognathism. Two patients had adactyly, syndactyly and brachydactyly. None of the five patients had Poland anomaly, hip dislocation or dysplasia but all had a mild degree of scoliosis. We observed congenital club-feet, calcaneovalgus deformities, macrodactyly of one or more toes or curly toes. Pedobarography showed plantar pressures within normal ranges.
  
  
  
  Adherence to standard diagnostic criteria is central in the diagnosis of MS. An accurate diagnosis is the basis for correct discussion of other relevant concomitant symptoms of MS, genetic testing and evaluation of prognosis. The multidisciplinary approach and adherence to diagnostic criteria taken in present study increases the knowledge on the relationship between genotype, phenotype and symptomatology of MS.
authors.affiliation: Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. line.kjeldgaard.pedersen@clin.au.dk.|Department of Childrens Orthopaedics, Aarhus University Hospital, Aarhus, Denmark. line.kjeldgaard.pedersen@clin.au.dk.
authors.forename: Line Kjeldgaard
authors.initials: LK
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.|Department of Gynaecology-Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Rikke Damkjær
authors.initials: RD
authors.lastname: Maimburg
authors.affiliation: Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.
authors.forename: Jens Michael
authors.initials: JM
authors.lastname: Hertz
authors.affiliation: Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Gjørup
authors.affiliation: Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.|Department of Orthodontics, Aarhus University, Aarhus, Denmark.
authors.forename: Thomas Klit
authors.initials: TK
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.|Department of Childrens Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Møller-Madsen
authors.affiliation: Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: John Rosendahl
authors.initials: JR
authors.lastname: Østergaard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D020331:Mobius Syndrome / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology*; D055815:Young Adult
keywords: Children; Moebius Sequence; Multidisciplinary Approach; Rare Disease