title: Marcus Gunn jaw-winking synkinesis: clinical features and management.
abstract: OBJECTIVE
  To evaluate the clinical features including eyelid excursion and management of Marcus Gunn jaw-winking synkinesis (MGJWS).
  
  
  METHODS
  Observational case series.
  
  
  METHODS
  Forty-eight consecutive patients with MGJWS.
  
  
  METHODS
  Clinical features and management of 48 patients with MGJWS were reviewed retrospectively. Upper eyelid excursion was measured and graded. Complications of surgical intervention were evaluated.
  
  
  METHODS
  Resolution of MGJWS and symmetry of upper eyelids in primary position.
  
  
  RESULTS
  Excursion of the ptotic eyelid with jaw movement in MGJWS was graded as mild (<2 mm) in 16% of patients, moderate (2-4 mm) in 76% of patients, and severe (> or = 5 mm) in 8% of patients. Thirty patients with moderate or severe MGJWS underwent disabling of the involved levator muscle and bilateral or unilateral frontalis suspension and had more than 6 months of follow-up. After a mean follow-up of 62 months, MGJWS resolved in 29 (97%) patients and improved from 6 mm to 2 mm in 1 (3%) patient. Relative upper eyelid height was within 1 mm in 87% of patients in primary position and within 1 mm in 80% of patients in downgaze. Twenty-six patients had bilateral frontalis suspension with disabling of unilateral levator muscle on the involved side. Relative upper eyelid height was within 1 mm in 88% of patients in the primary position and within 1 mm in 88% of patients in downgaze. Four non-amblyopic patients had unilateral frontalis suspension with levator muscle disabling. Relative upper eyelid height was symmetrical in 75% of the patients in primary position and in 25% of patients in downgaze. Complications included eyelash ptosis in 10% of the patients, loss of eyelid crease in 10%, and entropion in 3%.
  
  
  CONCLUSIONS
  Most of the patients with MGJWS exhibited moderate eyelid excursion. Disabling of the involved levator muscle and bilateral frontalis suspension and, in selected cases, disabling of the involved levator muscle and unilateral frontalis suspension were effective in the treatment of MGJWS. Eyelash ptosis and loss of eyelid crease were the most common complications, each occurring in 10% of the patients.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Eye Plastic, Orbital and Facial Cosmetic Surgery Service, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan 48105, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Bartley R
authors.initials: BR
authors.lastname: Frueh
authors.forename: Christine C
authors.initials: CC
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D001763:Blepharoptosis / Q000175:diagnosis* / Q000601:surgery; D001767:Blinking; D002648:Child; D002675:Child, Preschool; D005143:Eyelids / Q000294:innervation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008334:Mandible; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000601:surgery; D009801:Oculomotor Muscles / Q000294:innervation / Q000601:surgery*; D009802:Oculomotor Nerve / Q000002:abnormalities; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D014276:Trigeminal Nerve / Q000002:abnormalities; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult