Marcus Gunn jaw-winking phenomenon: a new supplemental test in the preoperative evaluation.
OBJECTIVE
To introduce a new method for the evaluation of Marcus Gunn jaw-winking ptosis that more precisely defines the severity of blepharoptosis.


METHODS
A retrospective review of 16 consecutive patients with Marcus Gunn jaw-winking ptosis presenting to our institution between 1993 to 1999 was performed. The position of the affected eyelid was observed after applying a technique of jaw immobilization and disruption of fusion with temporary occlusion of the ipsilateral side.


RESULTS
In patients presenting with mild to moderate Marcus Gunn jaw-winking, the majority (62.5%) demonstrated a positive test, uncovering complete or near complete ptosis. Test results were partially positive in 3 patients (18.8%) with increased but not complete ptosis and negative in 3 patients (18.8%) with no change in eyelid position.


CONCLUSIONS
Blepharoptosis associated with Marcus Gunn jaw-winking phenomenon is often more severe than found by conventional clinical evaluation. This finding may explain the frequent undercorrection and unpredictable results following levator resection. In patients exhibiting a positive jaw-winking ptosis test, disappointing outcomes with levator resection may be avoided by instead proceeding with a frontalis suspension with levator disinsertion as recommended for ptosis with severe jaw winking.
Wong
J F
JF
Department of Ophthalmology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Thériault
J F
JF
Bouzouaya
C
C
Codère
F
F
D000293:Adolescent; D000328:Adult; D001763:Blepharoptosis / Q000151:congenital / Q000175:diagnosis* / Q000601:surgery; D001767:Blinking; D002648:Child; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological; D005143:Eyelids / Q000294:innervation*; D005152:Facial Muscles / Q000294:innervation* / Q000601:surgery; D006801:Humans; D007223:Infant; D007568:Jaw / Q000294:innervation*; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000294:innervation* / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D013577:Syndrome; D014276:Trigeminal Nerve / Q000002:abnormalities* / Q000601:surgery