KUMJ | VOL. 13 | NO. 1 | ISSUE 49 | JAN-MAR, 2015
Surgical Outcomes in Cases of Marcus-Gunn Jaw-Winking Phenomenon
Sthapit PR, Saiju R
Abstract: Background
Markus-Gunn Jaw-winking Phenomenon (MGJW) is a congenital ptosis associated
with synkinetic movement of upper lid on masticating movements of jaw. It
results from aberrant connection between motor division of trigeminal nerve and
oculomotor nerve.
Objective
To investigate the clinical characteristics of MGJW phenomenon and evaluate its
surgical outcomes of unilateral levator excision and frontalis suspension.
Method
It is a retrospective analysis of nine cases of MGJW phenomenon seen from 2007
to 2013 AD. The clinical features were recorded and analysed. Unilateral levator
excision and frontalis suspension for the correction of synkinesis and ptosis was done
for all the patients. The result of surgery was analysed.
Result
MGJW phenomenon was seen more in males. All the cases had unilateral ptosis with
jaw winking phenomenon. Ipsilateral hypotropia and refractive errors were seen
in 44%. One week post operative margin reflex distance was good in 67% of cases.
Persistent jaw-winking was seen in 3 cases, two underwent repeat surgery to abolish
the synkinesis. At one year follow up, 33% had good margin reflex distance of more
than 4mm and 22% had fairly good margin reflex distance of 3mm.
Conclusion
Patients with Marcus Gunn jaw winking synkinesis can present at a wide age range.
There may be an associated vertical muscle imbalance, which should be managed
before ptosis surgery to avoid ptosis under correction. Unilateral frontalis flap
suspension combined levator excision can correct ptosis very well for patients with
Marcus-Gunn syndrome.
Keyword : Congenital ptosis, frontalis sling, levator excision, markus gunn jaw winking synkinesis.
