ABSTRACT
Marcus Gunn jaw-winking phenomenon is the most common form of congenital synkinetic neurogenic ptosis. The unilaterally ptotic eyelid elevates with jaw movements due to cross innervations between oculomotor nerve and mandibular branch of trigeminal nerve. We report a case of a 12-year-old female who presented with complaint of drooping of left upper lid since birth associated with elevation of left upper lid while chewing. She was diagnosed to have Marcus Gunn jaw-winking syndrome.
ABSTRACT
PURPOSE: To report a case of bilateral Marcus Gunn syndrome, which can be easily overlooked. CASE SUMMARY: A 6-year-old boy visited our clinic complaining of right ptosis. On ocular examination, the palpebral fissure width was 4 mm in the right lid and 7 mm in the left lid. Marginal reflex distance 1 (MRD 1) was -1 mm in the right lid and 2 mm in the left lid. Bilateral levator muscle function was good. When the patient moved the jaw to the right side, the left eyelid was retracted by 2 mm, and when the jaw was moved to the left side, the right upper eyelid retracted by 4 mm, which showed a moderate bilateral jaw-winking phenomenon. There was no change in bilateral palpebral fissure width when only opening the mouth without jaw movement. CONCLUSIONS: Asymmetrical bilateral ptosis can be easily misdiagnosed for unilateral ptosis, and concurrent Marcus Gunn phenomenon can exist. Therefore, a thorough examination is necessary when examining a ptosis patient.
Subject(s)
Child , Humans , Blepharoptosis , Eyelids , Heart Defects, Congenital , Jaw , Jaw Abnormalities , Mouth , Muscles , Nervous System Diseases , Reflex , Reflex, AbnormalABSTRACT
The most common type of ocular miswiring is Marcus Gunn jaw winking phenomenon and Duane's retraction syndrome and the next most common is pseudo inferior oblique overaction. The association of Marcus Gunn jaw winking and pseudo inferior oblique overaction has not been previously reported. The authors describe a 21-year-old woman with both Marcus Gunn jaw winking phenomenon and pseudo inferior oblique overaction. This coexistence in the present case may provide some support to the existing concept that both phenomena are caused by an ocular aberrant innervation. This unusual combination suggests that multiple aberrant innervation patterns can occur in the same patient. The occurrence of ocular miswiring is more common than is indicated by the few reports in the literature.
Subject(s)
Female , Humans , Young Adult , Blinking , Duane Retraction Syndrome , JawABSTRACT
The authors operated 7 cases with severe ptosis and moderate to severe jaw-winking phenomenon, with the extirpation of the levator muscle above Whitnall's ligament on affected eye and the bilateral frontalis suspension with preserved fascia lata. Seven patients observed for up to 22.5 months have had cosmetically and functionally desirable results with disappearance of jaw-winking phenomenon.