Strabismus surgery in children with Mobius syndrome

Mobius syndrome is a congenital disorder of facial diplegia associated with lateral gaze paralysis. Although palsy of the sixth and seventh cranial ne rves is the minimum diagnostic finding for Mobius syndrome, neuropathologic evidence indicates that this is a more complex syndrome.(1) Clinically, it is characterized by a total absence of facial expression and severe esotro pia, Other anomalies may be associated with this syndrome, especially other cranial nerve palsies and Poland syndrome, The etiology of this syndrome h as not been clearly established. Brain stem necrosis resulting from a vascu lar deficiency has been offered as a possible pathogenetic explanation.(2) The strabismus in Mobius syndrome is congenital esotropia with bilateral li mitation in abduction, Even though many reports have described the various features of Mobius syndrome, only a few articles have reported the results of strabismus surgery in children, including bimedial rectus muscle recessi on.(3-5) Some authors report that bilateral medial rectus muscle recession alone has been disappointing; therefore, a combination of a medial rectus m uscle recession and a lateral rectus muscle resection was recommended for s atisfactory results.(5-7) In more severe cases, muscle transposition was ne eded to ensure straight position of the eyes in primary gaze.(8,9)