Jaw Winking

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Identifier 161-1
Title Jaw Winking
Ocular Movements Congenital Unilateral Ptosis; Jaw Winking; Trigemino-oculomotor Synkinesis
Creator Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Contributor Primary Shirley H. Wray, MD, PhD, FRCP, Professor of Neurology, Harvard Medical School; Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Subject Congenital Unilateral Ptosis; Jaw Winking; Lid Winking; Trigemino-oculomotor Synkinesis; Marcus-Gunn Jaw Winking Phenomenon; Congenital Ptosis; Marcus Gunn Jaw Wink
Presenting Symptom Eyelid twitch
History This young boy was born at full term after a normal pregnancy with congenital unilateral ptosis of the left eyelid. His mother noticed that when he was sucking on a bottle the ptotic eyelid opened and closed. A diagnosis of the Marcus-Gunn jaw winking phenomenon was made. The first case of this unusual synkinesis between the pterygoid muscles and the levator muscle was reported in 1883 by Gunn. He described a 15 year old girl with congenital ptosis that recovered when she actively moved her mouth or when she moved her jaw to the left with her mouth closed. In 1895 Sinclair named the disorder the "Marcus Gunn jaw-winking phenomenon". In 1959 Sano called the associated movements of lid and jaw "trigemino-oculomotor" synkinesis and subdivided them into an external pterygoid-levator synkinesis and an internal pterygoid-levator synkinesis. Simultaneous contraction of the levator palpebrae superioris with the external pterygoid muscle is the most common synkinesis as in this child. The affected eyelid is usually ptotic and involuntary elevation of the lid can occur: a) when the mandible is moved to the opposite side (contraction of the ipsilateral external carotid muscle) b) when the mandible is projected forward or the tongue protruded (bilateral contraction of the external carotid muscles) or c) on wide opening of the mouth (i.e. strong depression of the mandible). The lid remains elevated as long as the jaw muscle contracts. The abnormal levator contraction is most evident when the patient is looking downward. Patients with the Marcus-Gunn jaw winking phenomenon commonly have associated ocular abnormalities including strabismus, amblyopia, anisometropia, and congenital nystagmus. Eyelid surgery is the treatment of choice when age permits and the parents and surgeon agree that the jaw winking, ptosis or both are cosmetically objectionable.
Clinical The Marcus-Gunn jaw winking phenomenon is well illustrated by this little boy who shows: • Partial ptosis of the left eyelid • Slight elevation of the left eyebrow • Lid winking on movement of his jaw horizontally - the eyelid appears to go up when the jaw is moved to the right and down when the jaw is moved to the left. • No lid winking is seen when he opens his mouth or on eye movement. The second clip, taken when he was a little younger, shows: • Almost complete ptosis OS • Strabismus with the left eye esotropic • Full eye movements • Striking Marcus-Gunn jaw winking
Etiology Congenital trigemino-oculomotor synkinesis
Disease/Diagnosis Congenital trigemino-oculomotor synkinesis; Marcus-Gunn Jaw Winking Phenomenon
Treatment In 1965, Beard described an operation to correct the Marcus- Gunn jaw winking phenomenon. He suggested performing a bilateral excision of the levator muscle followed by a bilateral frontalis sling using autogenous fascia lata. Other authors have now suggested alternative operations to correct this same defect (ref 1).
References 1. Beard C. Ptosis ed 2. St. Louis C.V. Mosby Co 1976;pp49:213. 2. Bullock JD. Marcus-Gunn Jaw-Winking Ptosis: Classification and Surgical Management. J Ped Ophthalmol Strabismus 17:375-379. http://www.ncbi.nlm.nih.gov/pubmed/7205518 3. Gunn RM. Congenital ptosis with peculiar associated movements of the affected lid. Trans Ophthalmol Soc UK 1883;3:283-287. 4. Sano K. Trigemino-oculomotor synkinesis. Neurologia 1959; 1:29-51. 5. Sinclair WW. Abnormal associated movements of the lids. Ophthalmol Rev. 1895; 14:307-319.
Relation is Part of 169-29
Contributor Secondary Steve Smith, Videographer
Reviewer David Zee, M.D., Johns Hopkins Hospital, 2007
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 1980
Type Image/MovingImage
Format video/mp4
Source 16mm tape
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6sx99sd
Setname ehsl_novel_shw
Date Created 2007-03-08
Date Modified 2017-11-27
ID 188578
Reference URL https://collections.lib.utah.edu/ark:/87278/s6sx99sd
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