Treatment of Severe Skeletal Open Bite Deformity in Patients With Mobius Syndrome: A Report of 3 Cases

Purpose: To investigate the treatment of severe skeletal open bite deformities in Mobius syndrome patients. Materials and Methods: Three patients aged 17 to 24 years (2 male patients and 1 female patient) with Mobius syndrome were evaluated and treated with preoperative orthodontics, orthognathic surgery, and postoperative orthodontic management. One patient was treated by bilateral V osteotomies of the mandibular body and one patient with bilateral V osteotomies of the mandibular body plus a Le Fort I osteotomy. The third patient had bilateral mandibular ramus sagittal split osteotomies in combination with maxillary osteotomies. Two of the patients had preoperative electromyographic studies on the temporalis and masseter muscles. Results: Postoperative and post-orthodontic stability was good in 2 cases, whereas a 5-mm anterior open bite developed after treatment in 1 case and additional orthodontic management was required to re-establish good occlusion. Potential to redevelop anterior open bites may likely be related to the functional deficiencies of the muscles of mastication and facial paralysis. Two patients who had electromyographic studies to evaluate muscle function showed lower-than-normal function of the temporalis and masseter muscles. Lower lip ptosis remained a significant esthetic issue in 2 of 3 patients. Conclusions: Patients with Mobius syndrome with severe skeletal open bite deformities can be treated with combined orthodontic and orthognathic surgery; however, there is a tendency for redevelopment of an anterior open bite with the surgical and orthodontic techniques used in these cases. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:e389-e399, 2012