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Surgical Outcomes in Cases of Marcus-Gunn Jaw-Winking Phenomenon
1Department of Ophthalmology Dhulikhel Hospital, Kathmandu University Hospiital Dhulikhel, Kavre, Nepal.
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.
Insights
The Marcus Gunn jaw-winking (MGJW) phenomenon, a congenital ptosis, can be effectively treated with unilateral levator excision and frontalis suspension surgery. This surgical approach shows promising results in correcting both ptosis and synkinesis.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Marcus Gunn jaw-winking (MGJW) phenomenon is a congenital ptosis characterized by synkinetic upper eyelid movement with jaw motion.
- It arises from abnormal connections between the trigeminal and oculomotor nerves.
Purpose of the Study:
- To investigate the clinical features of MGJW phenomenon.
- To evaluate the surgical outcomes of unilateral levator excision and frontalis suspension for MGJW.
Main Methods:
- Retrospective analysis of nine MGJW cases from 2007-2013.
- Clinical features were recorded and analyzed.
- All patients underwent unilateral levator excision and frontalis suspension surgery.
Main Results:
- MGJW was more prevalent in males, with all cases presenting unilateral ptosis and jaw winking.
- Associated ipsilateral hypotropia and refractive errors were observed in 44% of cases.
- Post-operative results showed good margin reflex distance in 67% at one week, with persistent synkinesis in 3 cases requiring repeat surgery.
Conclusions:
- MGJW can occur across a wide age range and may be associated with vertical muscle imbalance, requiring pre-surgical management.
- Unilateral frontalis flap suspension combined with levator excision effectively corrects ptosis in Marcus Gunn syndrome.
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