Jaw ‑ winking phenomenon: Report of a case with review of literature.

Jaw‑winking or the Marcus Gunn phenomenon (MGP), a congenital uncommon condition characterized by involuntary elevation of a drooping upper eyelid concomitant with various movements of the mandible, is well‑documented in medical literature, but very little information is available in dental literature. This is an interesting case report of a 17‑year‑old female with MGP, who reported for orthodontic treatment of her proclined upper anterior teeth, severe lower crowding, and mandibular micrognathia. Review of the literature revealed only two reported cases of dental anomalies in conjunction with MGP. The patient also gave a positive family history of MGP with a maternal cousin having a similar problem. Dentists and other oral health professionals can play a significant role in detection and diagnosis of this rare condition and should take protective measures during dental and oral surgical procedures.

Marcus Gunn Jaw-Winking Phenomenon: Brief Communication.

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.

A Case of Bilateral Marcus-Gunn Syndrome

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 When the patient moved the jaw to the right side, the left eyelid was retracted by 2 mm, and when the jaw was moved to the left side, the right upper eyelid retracted by 4 mm, which showed a moderate bilateral jaw-winking phenomenon.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.

A Case of Marcus Gunn Jaw Winking and Pseudo Inferior Oblique Overaction

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.

The Surgical Treatment of Ptosis with Marcus-Gunn(Jaw-Winking) Phenomenon

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.

The Clinical Study On the Surgical Methods of Synkinetic Ptosis Treatment

Synkinetic ptosis refers to abnormal vertical movement of upper eyelid. This abnormal elevation of the eyelid results from opening or closing of the mouth, chewing, sucking, and movement of jaw outward or toward the contralateral side. A number of other stimuli for the phenomenon have been described. These include smile, sternocleidomastoid contraction or tongue protrusion, inspiraion, and voluntary nystagmus. This type of ptosis was most commonly seen with a congenital Marcus-Gunn jaw-winking syndrome. Usually this movement is thought to be due to a congenital misdirection of some of the 5th cranial nerve fibers into the branch of the 3rd cranial nerve that supplied the levator muscle. We experienced 6 cases of synkinetic ptosis, among them, interesting enough, one was typical elevation of upper lid in smile due to misdirection between the oculomotor and facial nerve fibers. The cosmetic problem was the first purpose of the surgery. So, we performed a levator extirpation with frontalis suspension on 4 cases who had the severe jaw-winking phenomenon and undertook only fron talis suspension on 2 cases and one of whom had poor superior rectus function. In the cases who have undergone levator extirpation with frontalis suspension, synkinetic movement was improved in all. However, in those who underwent the frontalis suspension procedure, the synkinetic phenomenon still remained in spite of acceptable improvement of blepharoptosis in primary position.