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Modified technique of levator plication for the correction of Marcus Gunn jaw-winking ptosis: a case series

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An Erratum to this article was published on 08 April 2015

Abstract

To conduct a study on ptotic eyelids with Marcus Gunn jaw-winking ptosis operated via a technique of modified levator plication, prospective interventional case series. Ten ptotic eyelids with Marcus Gunn jaw-winking phenomenon (MGJWP) underwent modified levator plication surgery. Postoperatively, all cases were followed up for at least 6 months. Outcome parameters included amount of ptosis correction, amount of MGJWP correction, palpebral aperture height, lid lag, and lagophthalmos. The mean amount of ptosis was 4.25 ± 0.79 mm (range of 3–6 mm), mean amount of MGJWP was 5.10 ± 2.27 mm (range 2–9 mm), and the mean levator function was 8.3 ± 2.27 mm (range of 4–12 mm). At 6 months follow-up, good correction of ptosis was seen in nine out of ten patients. Resolution of MGJWP (≤1 mm of excursion of upper eyelid with synkinetic mouth movement) was seen in three patients. Improvement in MGJWP (>1 mm of excursion of upper eyelid with synkinetic mouth movement) was seen in seven patients. The mean post-operative lagophthalmos was 0.80 ± 0.88 mm. The modified levator plication technique was effective in the treatment of MGJWP. This modified technique of levator plication is anatomically less destructive and hence more acceptable, with the added advantages of less post-operative lagophthalmos and no lid contour defects.

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References

  1. Gunn RM (1883) Congenital ptosis with peculiar associated movements of the affected lid. Trans Ophthal Soc UK 3:283–287

    Google Scholar 

  2. Altman K (1990) The Marcus Gunn jaw-winking phenomenon—a case report. Br J Oral Maxil Surg 28:52–54

    Google Scholar 

  3. Pratt SG, Beyer CK, Johnson CC (1984) The Marcus Gunn phenomenon: a retrospective review of 71 cases. Ophthalmology 90:27–30

    Article  Google Scholar 

  4. Iliff CE (1970) The optimum time for surgery in the Marcus Gunn phenomenon. Trans Am Acad Ophthalmol Otolaryngol 74:1005–1010

    CAS  PubMed  Google Scholar 

  5. Bradley WG, Toone KB (1967) Synkinetic movements of the eyelid: a case with some unusual mechanisms of paradoxical lid retraction. J Neurol Neurosurg Psychiatry 30(6):578–579

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Duke Elder S (1963) Normal and abnormal development; congenital deformities. In: System of ophthalmology vol 3, pt 2. St. Louis, CV Mosby, pp. 900–905

  7. Shukla SP (1966) Marcus Gunn phenomenon. Ind J Ophthalmol 14(5):223–224

    CAS  Google Scholar 

  8. James WL (1987) The Marcus Gunn phenomenon: discussion and report of a case. Oral Med 64:687–692

    Google Scholar 

  9. Tsai CC, Lin TM, Lai CS, Lin SD (2002) Use of orbicularis oculi muscle flap for severe MG ptosis. Ann Plast Surg 48(4):431–434

    Article  PubMed  Google Scholar 

  10. Doucet TW, Crawford JS (1981) The quantification, natural course and surgical results in 57 eyes with Marcus Gunn (Jaw-Winking) syndrome. Am J Ophthal 92:702–707

    Article  CAS  PubMed  Google Scholar 

  11. Beard C (1981) Ptosis Ed 3. St Louis, C.V. Mosby, pp. 76–83, 84–143, 150–174, 184–207

  12. Pratt SG, Beyer CK, Johnson CC (1984) The Marcus Gunn phenomenon : a retrospective review of 71 cases. Ophthalmology 90:27–30

    Article  Google Scholar 

  13. Putterman AM (1973) Jaw-winking blepharoptosis treated by the Fasanella-Servat procedure. Am J Ophthalmol 75(6):1016–1022

    Article  CAS  PubMed  Google Scholar 

  14. Neuhaus RW (1985) Eyelid suspension with transposed LPS muscle. Am J Ophthalmol 100(2):308–311

    Article  CAS  PubMed  Google Scholar 

  15. Callahan A (1972) Correction of unilateral blepharoptosis with bilateral eyelid suspension. Am J Ophthal 74:321–326

    Article  CAS  PubMed  Google Scholar 

  16. Fasanella RM, Servat J (1961) Levator resection for minimal ptosis. Arch Ophthalmol 65:493

    Article  CAS  PubMed  Google Scholar 

  17. Bullock JD (1980) Marcus-Gunn jaw-winking ptosis: classification and surgical management. J Pediatr Ophthalmol Strabismus 17(6):3759

    Google Scholar 

  18. Khwarg SF, Tarbet KJ, Dortzbach RK, Lucarelli MJ (1999) Management of moderate to severe Marcus Gunn jaw-winking ptosis. Opthalmology 106(6):1191–1196

    Article  CAS  Google Scholar 

  19. Demirci H, Frueh BR, Nelson CC (2010) Marcus Gunn jaw-winking synkinesis: clinical features and management. Ophthalmology 117(7):1447–1452

    Article  PubMed  Google Scholar 

  20. Bajaj M, Pushker N, Mahindrakar A (2004) Advancement of Whitnall’s ligament via conjunctival approach for correction of congenital ptosis. Orbit 23(3):153–159

    Article  PubMed  Google Scholar 

  21. Jones LT, Quickert MH, Wobig JL (1975) The cure of ptosis by aponeurotic repair. Arch Ophthalmol 93:629–634

    Article  CAS  PubMed  Google Scholar 

  22. Smith B, McCord CD, Baylis H (1969) Surgical treatment of blepharoptosis. Am J Ophthalmol 68(1):92–99

    Article  CAS  PubMed  Google Scholar 

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None of the authors has conflict of interest with the submission.

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The authors have no financial or proprietary interest in a product, method, or material described herein.

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The study was performed with informed consent and following all the guidelines for experimental investigations required by our Institute’s Ethics Committee.

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Correspondence to Dewang Angmo.

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Bajaj, M.S., Angmo, D., Pushker, N. et al. Modified technique of levator plication for the correction of Marcus Gunn jaw-winking ptosis: a case series. Int Ophthalmol 35, 587–591 (2015). https://doi.org/10.1007/s10792-015-0060-z

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  • DOI: https://doi.org/10.1007/s10792-015-0060-z

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