Anesthetic management of children with Moebius sequence.

Journal Article (Journal Article)

BACKGROUND: Moebius sequence is a rare congenital absence of the sixth and seventh cranial nerves, although there may be additional congenital cranial neuropathies. Developmental delay, cardiac and musculoskeletal abnormalities may also co-exist. Oro-facial manifestations include bilateral facial nerve palsy resulting in a mask like facies, drooling, incomplete eye closure, and strabismus secondary to the extra-ocular muscle imbalance. This condition has multiple implications for anesthetic care. METHODS: We reviewed 111 anesthesia records of 46 patients with Moebius sequence for anesthesia technique and related complications. RESULTS: Facial nerve palsy was universally present and bilateral in 44 (93.6%) patients. Thirty-two (68%) had concomitant sixth nerve palsy. Oro-facial and limb abnormalities were present in 16 (35%) and 18 (39%) of patients respectively. Endotracheal intubation, when attempted, was easy in 76 of 106 cases. Tracheal intubation was consistently difficult in seven patients and intubation failure occurred in a single patient only. Statistically significant factors associated with difficult tracheal intubation included structural abnormalities of the mandible and palate and abnormalities of four cranial nerves (IX, X, XI, XII). CONCLUSION: We confirm that tracheal intubation may be difficult in patients with Moebius sequence. We identify disease features that might predict a difficult tracheal intubation and thus allow the anesthesiologist an opportunity to plan accordingly.

Full Text

Duke Authors

Cited Authors

  • Ames, WA; Shichor, TM; Speakman, M; Zuker, RM; McCaul, C

Published Date

  • October 2005

Published In

Volume / Issue

  • 52 / 8

Start / End Page

  • 837 - 844

PubMed ID

  • 16189336

International Standard Serial Number (ISSN)

  • 0832-610X

Digital Object Identifier (DOI)

  • 10.1007/BF03021779


  • eng

Conference Location

  • United States