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Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal

mise à jour du
8 avril 2012
Moëbius Syndrome and Yawning
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Congenital facial paralysis refers to conditions that are acquired during or at birth (e.g. from trauma), while developmental facial paralysis (DFP) is the result of developmental mishaps during fetal development. DFP can present in isolation or as part of a recognised syndrome, such as Moëbius, Goldenhar, etc.
In general, DFP carries a poor functional prognosis and the importance of early recognition and treatment has been stressed by many authors, while most traumatic cases are likely to recover spontaneously.
The facial nerve arises from the brain stem nuclei. The motor fibers of the facial nerve loop dorsally around the abducens nerve nucleus and exit at the cerebellopontine angle. The parasympathetic and sensory fibers form the nervus intermedius which join the motor root of the facial nerve as it exits the brainstem.
The course of the facial nerve is divided into the cisternal segment in the cerebellopontine angle, the intracanalicular segment, the labyrinthine segment and the tympanic segment (separated by the anterior genu), the mastoid segment (separated by the posterior genu), and the extracranial segment.Several branches are given off during the intrapetrosal course. The extracranial segment consists mainly of the parotid portion of the facial nerve and its terminal branches that innervate the facial musculature.
The facial nerve begins to develop at 3 weeks of life from the facio-acoustic primordium and is intimately related to the structures of the middle ear, external ear, parotid gland, and facial muscles. The neural connections are completely established by the 16th week of fetal life, while the facial nerve separates from the acoustic nerve at 5-6 weeks of fetal life. Therefore, an in utero insult prior to this time, can affect both nerves. The facial canal continues to develop after the 16th week and the ossification is completed by the end of the first year of life. The inner ear and internal auditory canal undergo a different embryogenesis.
Although causes of DFP have been attributed to an agenesis of the petrous portion of the temporal bone, with resulting agenesis of the facial nerve, it should be pointed out, that the bone and cartilage formation occur after the development of the facial nerve and thus appear unable to influence the nerve itself.
At birth, the anatomy of the facial nerve approximates that of the adult with the exception of the nerve's exit through the superficially located stylomastoid foramen, making the facial nerve vulnerable to compression injury from the shoulder during intrauterine life, the maternal pelvis in labor, or the forceps during delivery. The mastoid tip develops postnatally which affords greater protection to the nerve in later life.
Moëbius syndrome, or better Moëbius sequence, is a non-progressive congenital condition with an estimated prevalence of 0.0002- 0.002% of births.In most studies, Moëbius sequence has been defined as a congenital facial weakness with congenital impairment of ocular abduction.
Moëbius'syndrome represents a broad spectrum of clinical findings ranging from isolated unilateral facial paralysis to bilateral absence of facial and abducens nerve function. Multiple other cranial nerves, including the glossopharyngeal, vagus, hypoglossal, and other extraocular motor nerves, can be affected.
The complete pathophysiological description of Möbius syndrome remains elusive. Whether nerve, brainstem, or muscle aplasia is the primary event has not been established. Genetic factors, teratogens and vascular anomalies have been linked with the aetiopathogenesis of the syndrome.
Because of the early age at which the syndrome becomes apparent, affected individuals generally are brought to medical attention by their parents or other caretakers as infants.
Facial and ocular symptoms are usually the presenting problems:
Facial diplegia is the most noticeable symptom. This may be observed soon after birth with incomplete eyelid closure during sleep, drooling, and difficulty sucking.
On occasion, the facial paralysis is not noticed for a few weeks or months until the inability to smile, to yawn or the lack of facial movement with crying arouses the parents' concern.
Because of the facial and forehead immobility, the skin appears devoid of wrinkles. Inability to close the mouth is the rule.
Speech is usually indistinct secondary to the inability to close the lips and make labial sounds. While eating, food is apt to lodge in the cheeks.
Intelligence is usually normal, but mild mental retardation is thought to occur in about 10% of cases. The intelligence may be underestimated without formal testing because of the facial appearance.
Terzis JK, Anesti K. Developmental facial paralysis: a review. J Plast Reconstr Aesthet Surg. 2011;64(10):1318-1333.
Briegel W, Hofmann C, Schwab KO. Behaviour problems of patients with Moebius sequence and parental stress. J Paediatr Child Health. 2010;46(4):144-148

57 answers collected (2012, april 8)
At what age were you diagnosed with Mebius syndrome?
before birth: 5 = 9,6%
before 1 month of life: 9 = 17,3%
between 1 month & 12 months old: 26 = 50%
between 1 & 6 years old: 5 = 9,6%
after 6 years old: 7 = 13,5%
Did your mother have an ultrasound while pregnant with you?
yes: 40 = 80,0%
no: 10 = 20,0%
Was the diagnosis suspected?
yes: 1 = 1,9%
no : 51 = 98,1%
If yes on which criteria ?
facial palsy: 0 = 0%)
lack of facial movements: 0 = 0%
lack of yawning: 1 = 14,3%
Do you have paralysis of the 6th & 7th cranial nerves ?
yes: 35 = 71,4%
7 th alone: 1 = 2%
6 th & 7th & others: 13 = 26,5%
Do you yawn ?
never: 12 = 24%
5 to 10 yawns per day: 33 = 66%
10 to 20 yawns per day: 5 = 10%
more the 20 per day: 0 = 0%
Are you capable of voluntarily opening your mouth ?
yes: 48 = 94,1%
no: 3 = 5,9%
Is your yawn normal ?
yes: 31 = 67,4%
no: 15 = 32,6%
Is your yawn affected by the syndrome ?
yes: 19 = 41,3%
no: 27 = 58,7%
Are you sensitive to other people's yawns (do they make you yawn?
yes: 24 = 52,2%
no: 22 = 47,8%
Do your own yawns trigger yawns in others?
yes: 30 = 66,7%
no: 15 = 33,3%
Do you have sleep problems ?
insomnia: 3 = 6%
awaking during night: 7 = 14%
sleepiness during the day: 18 = 36,0%
no: 22 = 44%
How many hours do you sleep each night ?
less then 6 hours ? 5 = 9,6%
7 to 8 hours: 31 = 59,6%
8 to 10 hours: 11 = 21,2%
more then 10 hours: 5 = 9,6%
I submitted a survey on 2012 April 2. I have left some blanks so I hope to explain them here. Our son was adopted last year from Bulgaria at the age of 7. He had not been diagnosed with Moëbius Syndrome while in the orphanage. That diagnosis was made after we had him home for several months. We have never seen him yawn. We don't know if his mother had an ultrasound during her pregnancy. He does wake during the night about once or twice a week but it is still too soon to tell what the cause of it is. There are so many things that can be a factor after growing up in an orphanage for 7 years.
Thank you for your research. I hope to learn more of the connection between Moebius and yawning.
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