Möbius sequence with prenatal exposure to misoprostol

Objective
To present 3 cases of Möbius sequence exposed in utero to misoprostol and discuss their clinical presentations, etiopathogenesis, and management.

Methods
Medical records of 3 patients with Möbius sequence and prenatal exposure to misoprostol were reviewed. Clinical findings were compared with those reported in the literature.

Results
Lack of facial-muscle movement, lagophthalmos with secondary exposure keratitis, decreased ability to crease forehead, and shallow nasolabial fold imply facial-nerve dysfunction. Small- and large-angle esotropia and apparent orthotropia with abduction limitation showed varying degrees of abducens nerve involvement. Two patients had early prenatal exposure to misoprostol during the first 3 months of gestation.

Conclusion
A history of misoprostol exposure should be routinely elicited from parents of children with Möbius sequence. Associated deficiencies in Möbius sequence and its variants require a multidisciplinary approach.