The pictures above show a child with ptosis. What is the diagnosis? Answer Marcus-Gunn jaw winking ptosis. What is responsible for this appearance? Answer In Marcus-Gunn jaw winking ptosis, there is synkinetic innervation of the levator and the ipsilateral pterygoid muscle resulting in winking movement of the ptotic lid during mouth movement Would you recommend levator resection and why? Answer Levator resection does not address the problem of synkinesis so that the winking movement remains or becomes more obvious due to exposure of the upper sclera during the winking movement. The alternative procedure is levator recession followed by brow suspension. To avoid asymmetry the contralateral lidshould ideally undergo the same operation. However, most parents are not keen to take up such recommendation!
What is the diagnosis?
What is responsible for this appearance?
Would you recommend levator resection and why?
