Marcus-Gunn jaw winking ptosis
 

Right ptosis. Elevation of the right upper lid with jaw movement.

. This child has a right ptosis. The pupils and the ocular motility are normal. The ptotic eyelid rises on getting the patient to open the mouth and move the jaw from side to side.  In the examination: make sure you get the patient to move the jaw because mouth opening alone may not cause the wink look for eyelid scars from previous operation

Questions:

1. What is tought to be the cause of Marcus-Gunn jaw winking ptosis?

answer
Misdirection of trigeminal nerve fibre into the levator muscle. As a result stimulation of jaw result in impulse to the poorly innervated levator (synkinetic innervation of the leavtor and ipsilateral pterygoid muscle).

2. How would you treat Marcus-Gunn jaw winking ptosis?

answer
The treatment is mainly cosemtic. If the patient has significant synkinetic movement then the levator is disinserted followed by brow suspension. The suspension may need to be performed bilaterally to assure symmetry.

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