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Marcus-Gunn jaw winking syndrome: case series study and management algorithm.

Francesco M Quaranta-Leoni^1,2,3, Claudia Quaranta-Leoni⁴, Matteo Di Marino^1,5

¹Orbital and Adnexal Service, Tiberia Hospital - GVM Care & Research, Rome, Italy.

Orbit (Amsterdam, Netherlands)

|March 1, 2023

Summary

Treatment for Marcus Gunn jaw winking syndrome (MGJWS) varies by ptosis severity. Levator excision with frontalis suspension is recommended for severe ptosis and synkinesis, offering better outcomes than levator resection.

Keywords:

Marcus Gunn jaw winking syndrome frontalis flap frontalis suspension levator excision levator resection

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Area of Science:

Ophthalmology
Pediatric Ophthalmology
Oculoplastics

Background:

Marcus Gunn jaw winking syndrome (MGJWS) is a congenital condition characterized by abnormal elevation of the upper eyelid during jaw movement.
Treatment decisions for MGJWS are complex and depend on the degree of ptosis and synkinesis.

Purpose of the Study:

To establish a treatment rationale for patients diagnosed with Marcus Gunn jaw winking syndrome (MGJWS).

Main Methods:

A retrospective review was conducted on 38 patients with MGJWS.
Data collected included visual acuity, ocular motility, ptosis presence, levator function, and surgical management.
Thirty-two patients underwent surgical correction by a senior surgeon.

Main Results:

Levator advancement (LA) was effective for moderate ptosis but increased synkinesis.
Levator resection (LR) for severe ptosis had a high recurrence rate.
Uni- or bilateral levator excision (LE) with frontalis suspension (FS) or frontalis flap (FF) effectively corrected ptosis and resolved jaw winking in most cases.

Conclusions:

LA is suitable for moderate ptosis, but synkinesis may worsen.
LR is unpredictable for severe ptosis.
For severe ptosis with synkinesis, LE with FS or FF is the preferred surgical approach, with FF offering better cosmetic results in unilateral cases.