Marcus Gunn jaw-winking ptosis and contralateral lid retraction: management with Müller muscle-conjunctival resection with tarsectomy
Strabismus, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1080/09273972.2026.2708082
- Dergi Adı: Strabismus
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO)
- Anahtar Kelimeler: Lid retraction, Marcus Gunn jaw-winking syndrome, M & uuml;ller muscle-conjunctival resection, ptosis, synkinetic eyelid movement, tarsectomy
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Purpose: Marcus Gunn jaw-winking syndrome (MGJWS) is a rare congenital cranial dysinnervation disorder characterized by synkinetic eyelid elevation during jaw movement. Standard surgical management often involves levator excision with bilateral frontalis suspension, which abolishes levator function but carries morbidity and variable cosmetic outcomes. Posterior ptosis approaches such as Müller muscle–conjunctival resection (MMCR) are well established for phenylephrine-responsive ptosis, but their role in MGJWS remains unclear. Methods: A 12-year-old male with congenital left upper eyelid ptosis, jaw-winking, and contralateral lid retraction underwent clinical and phenylephrine testing. The phenylephrine test demonstrated a partial positive response, guiding surgical planning. An 8-mm MMCR combined with a 2-mm tarsectomy was performed under general anesthesia using a Putterman clamp technique. The excised tarsoconjunctival specimen was submitted for histopathological evaluation. Results: Preoperatively, margin reflex distance (MRD1) measured 2 mm in the left eye and 5 mm in the right. Post-phenylephrine instillation, MRD1 improved to 3 mm in the left eye. Surgery proceeded uneventfully. Histopathology revealed preserved Müller’s muscle fibers without structural abnormalities. At the 2-year postoperative follow-up, MRD1 measured 5 mm in the right eye and 3 mm in the left eye. The jaw-winking movement persisted postoperatively but decreased clinically from moderate to mild synkinesis. No lagophthalmos, exposure keratopathy, or other postoperative complications were observed. Conclusion: This case illustrates the use of MMCR combined with tarsectomy for correction of baseline ptosis and improvement of eyelid symmetry in a selected MGJWS patient with partial phenylephrine responsiveness. The procedure was not intended to abolish jaw-winking synkinesis; however, the synkinetic movement persisted postoperatively with clinical reduction from moderate to mild severity. Although posterior ptosis approaches are well established, this case suggests that MMCR with tarsectomy may have a limited role in carefully selected MGJWS cases when the primary goal is ptosis correction rather than elimination of synkinetic eyelid movement. Further studies are needed to evaluate the reproducibility and long-term stability of this approach.