Facial animation in patients with Moebius and Moebius-like syndromes

Sural nerve graft tunnelled across the face with the aid of nasal vestibule incisions.

Taking off the gracilis muscle. Only a part is used, usually the anterior third.

Muscle position in the subcutaneous pocket with venous (a) and arterious (b) repair; design of the site of anastomosis with the masseteric nerve (c).

Nine-year-old female patient with complete Moebius syndrome (a). The clinical examination revealed the impairment of the VI cranial nerve bilaterally. In October 2006 she underwent transplant of the gracilis muscle on the left side and on June 2007 transplant of the gracilis muscle on the right side. During both the operations 6g of fat were removed from the cheeks. Postoperative appearance while at rest (b) and while smiling (c).

Twenty-year-old male patient with a Moebius incomplete form. Some facial movements were observed, which were located in the lower face bilaterally with depressor anguli oris activity. Clinical examination revealed an impairment of the VI cranial nerve bilaterally and of the XII nerve on the left side. Preoperative view at rest (a) and smiling (b). The reconstruction was achieved by performing two free microneurovascular transfers of gracilis muscle flaps to the right and left cheeks in July 2004 and August 2005, respectively. During both the operations, 2g of fat were removed from the cheeks. Postoperative appearance while smiling (c) and with independent bilateral contractions (d and e).

Twelve-year-old female patient with a Moebius-like form on the left side. Preoperative appearance at rest (a) and while attempting to smile (b). In November 2005 a microsurgical reconstruction with the gracilis muscle was performed. The innervation of the muscle transfer was provided by the ipsilateral motor nerve to the masseter muscle. Postoperative appearance at rest (c) and while smiling (d).

Thirteen-year-old female patient with a Moebius-like form on the left side. Preoperative appearance at rest (a) and while attempting to smile (b). Clinical examination revealed impairment of the XII nerve ipsilaterally. The reconstruction was achieved with a cross-facial nerve graft from the right facial nerve in June 2003, and subsequently, a gracilis muscle transplantation in February 2004. Postoperative appearance at rest (c) and while smiling (d).