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CASE SERIES
Year : 2021  |  Volume : 59  |  Issue : 4  |  Page : 372-375

The dancing droopy lids: Marcus gunn jaw winking phenomenon in congenital ptosis – A case series


1 Department of Squint, Neuro-Ophthalmolgy and Pediatric Ophthalmmology, Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu, India
2 Department of Ophthalmology, Madurai Medical College, Madurai, Tamil Nadu, India
3 Department of Ophthalmology, Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Malarvizhi Raman
Department of Squint, Neuro-Ophthalmolgy and Pediatric Ophthalmmology, Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Egmore, Chennai - 600 008, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_70_21

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Marcus Gunn Jaw Winking Ptosis is a congenital ptosis associated with synkinetic movements of upper lid on masticating movements of the jaw. It is usually unilateral but rarely presents bilaterally. In this study, ten cases of unilateral ptosis since birth with moderate to severe degree movement of lids along movement of jaws (MGJW-Marcus Gunn Jaw Winking) presenting to Oculoplasty department were evaluated and managed according to the degree of jaw winking phenomenon and their outcomes were observed. The amount of jaw winking is the excursion of the upper lid in mm with the opening of the mouth. Ocular associations include strabismus (50-60%), anisometropia (5-25%) and amblyopia (30-60%). The cause for underlying amblyopia could be secondary to strabismus, anisometropia, or occlusion by the ptotic lid. It is graded into mild (maximum 2 mm), moderate (2 mm-5 mm) and severe (higher than 5 mm). Persistence of minimal jaw-winking phenomenon post-operatively after levator detachment. Frontalis sling is the most common procedure used to correct the ptosis following the obliteration of levator action. MGJWS mostly presented as moderate to severe jaw winking synkinesis of upper eyelid and accompanied by moderate to severe blepharoptosis. Eyelid excursion of jaw winking has direct correlation with ptosis and levator dysfunction. Unilateral levator aponeurosis excision with frontalis suspension is an effective surgical approach in the management of unilateral MGJWS, which achieved both satisfactory symmetrical outcome and resolution of jaw winking with eye movement.


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