Abstract
Purpose To investigate the association of ptosis, levator, and jaw winking in Marcus Gunn jaw-winking synkinesis (MGJWS), and the risk factor of preservation and outcomes of the unilateral levator excision and frontalis suspension. Methods Clinical features of MGJWS case series from 2011 to 2018 were retrospectively reviewed. Association between jaw winking and ptosis/levator function was statistically analyzed. The patients underwent unilateral levator excision and frontalis suspension using silicone rod or autogenous fascia lata. Clinical outcomes were evaluated in operated patients and the independent risk factors of residual jaw winking were investigated after a long follow-up. Results There were 42 MGJWS patients in 2011 to 2018, accounting for 2.87% of all congenital blepharoptosis. 80% of mild jaw winking was accompanied with mild ptosis and fair levator function, and moderate-to-severe jaw winking was often accompanied with moderate-to-severe ptosis and poor levator function (P < 0.05). Ptosis showed a strong association with excursion of jaw winking (R = 0.785, P < 0.01). Jaw winking was resolved in all 34 operated patients with good correction of ptosis. Severity of jaw winking is an independent risk factor for the residual synkinesis after surgery. Severe preoperative jaw winking had an 18.05 times increased risk of postoperative residual synkinesis compared with moderate jaw winking (P < 0.05). Conclusions In MGJWS eyelid excursion of jaw winking has a direct correlation with ptosis and dysfunction of levator muscle. Unilateral levator aponeurosis excision and frontalis suspension is an efficient approach for MGJWS. Severe jaw winking is a risk factor of residual eyelid synkinesis after surgery.
Highlights
Marcus Gunn syndrome, known as Marcus Gunn jawwinking synkinesis (MGJWS), was first described by Gunn in 1883 as a congenital unilateral ptosis with contraction of the levator palpebrae superioris in association with the external pterygoid muscle [1]
We retrospectively reviewed patients with MGJWS within all congenital ptosis patients at the Eye Center of e Second Affiliated Hospital of Zhejiang University from January 2011 to December 2018. e study was approved by the institutional review board of the hospital and conducted in accordance with the Declaration of Helsinki
All the patients underwent unilateral levator muscle excision followed by frontalis suspension of the involved eye
Summary
Marcus Gunn syndrome, known as Marcus Gunn jawwinking synkinesis (MGJWS), was first described by Gunn in 1883 as a congenital unilateral ptosis with contraction of the levator palpebrae superioris in association with the external pterygoid muscle [1]. MGJWS was reported to occur in 2%–13% of patients with congenital ptosis [2,3,4,5,6]. Infrequent cases with absence of ptosis in MGJWS were reported in previous studies, which occurred in 1.2%–6.0% of MGJWS patients [13, 14]. A variety of surgical techniques were reported, such as the Fasanella–Servat procedure [21], levator sling [22,23,24], Journal of Ophthalmology modified levator resection or plication [25], and levator muscle excision followed by frontalis suspension [10, 12, 18, 26]. Some ophthalmologists reported single eye surgery techniques, which got satisfied surgical outcomes as well
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