eMedicine Specialties > Ophthalmology > Lid

Marcus Gunn Jaw-winking Syndrome: Differential Diagnoses & Workup

Author: Sean M Blaydon, MD, FACS, Texas Oculoplastic Consultants, Austin, Texas
Contributor Information and Disclosures

Updated: Dec 19, 2008

Differential Diagnoses

Amblyopia
Extraocular Muscles, Actions
Extraocular Muscles, Anatomy
Oculomotor Nerve Palsy
Ptosis, Congenital

Other Problems to Be Considered

Aberrant third nerve regeneration
Double elevator palsy

Workup

Laboratory Studies

  • Creatine phosphokinase level: If a past medical or family history of any reactions to anesthesia exists, rule out the possibility of malignant hyperthermia prior to any surgery.

Other Tests

  • Basic tear secretion test: Normal measurement is more than 5-10 mm of Schirmer filter paper wetting after 5 minutes following application of topical anesthetic, such as proparacaine.

Histologic Findings

Light microscopy of surgical specimens usually reveals normal striated muscle. Fibrosis within the muscle has been reported.11

More on Marcus Gunn Jaw-winking Syndrome

Overview: Marcus Gunn Jaw-winking Syndrome
Differential Diagnoses & Workup: Marcus Gunn Jaw-winking Syndrome
Treatment & Medication: Marcus Gunn Jaw-winking Syndrome
Follow-up: Marcus Gunn Jaw-winking Syndrome
Multimedia: Marcus Gunn Jaw-winking Syndrome
References
[ CLOSE WINDOW ]

References

  1. Gunn RM. Congenital ptosis with peculiar associated movements of the affected lid. Trans Ophthal Soc UK. 1883;3:283-7.

  2. Pratt SG, Beyer CK, Johnson CC. The Marcus Gunn phenomenon. A review of 71 cases. Ophthalmology. Jan 1984;91(1):27-30. [Medline].

  3. Bradley WG, Toone KB. Synkinetic movements of the eyelid: a case with some unusual mechanisms of paradoxical lid retraction. J Neurol Neurosurg Psychiatry. Dec 1967;30(6):578-9. [Medline].

  4. Kirkham TH. Paradoxical elevation of eyelid on smiling. Am J Ophthalmol. Jul 30 1971;72(1):207-8. [Medline].

  5. Parry R. An unusual case of the Marcus Gunn syndrome. Trans Opthal Soc U K. 1957;77:181-5. [Medline].

  6. Kirkham TH. Familial Marcus Gunn phenomenon. Br J Ophthalmol. Apr 1969;53(4):282-3. [Medline].

  7. Beard C. Ptosis. 3rd ed. St. Louis: CV Mosby; 1981:46-9.

  8. Duke Elder S. Normal and abnormal development; congenital deformities. In: System of Ophthalmology. Vol 3, pt 2. St. Louis: CV Mosby; 1963:900-5.

  9. Hepler RS, Hoyt WF, Loeffler JD. Paradoxical synkinetic levator inhibition and excitation. An electromyographic study of unilateral oculopalpebral and bilateral mandibulopalpebral (Marcus Gunn) synkineses in a 74-year-old man. Arch Neurol. Apr 1968;18(4):416-24. [Medline].

  10. Wartenberg R. Winking-jaw phenomenon. Arch Neurol Psychiatry. Jun 1948;59(6):734-53. [Medline].

  11. Lyness RW, Collin JR, Alexander RA, et al. Histological appearances of the levator palpebrae superioris muscle in the Marcus Gunn phenomenon. Br J Ophthalmol. Feb 1988;72(2):104-9. [Medline].

  12. Khwarg SI, Tarbet KJ, Dortzbach RK, et al. Management of moderate-to-severe Marcus-Gunn jaw-winking ptosis. Ophthalmology. Jun 1999;106(6):1191-6. [Medline].

  13. Doucet TW, Crawford JS. The quantification, natural course, and surgical results in 57 eyes with Marcus Gunn (jaw-winking) syndrome. Am J Ophthalmol. Nov 1981;92(5):702-7. [Medline].

  14. Bowyer JD, Sullivan TJ. Management of Marcus Gunn jaw winking synkinesis. Ophthal Plast Reconstr Surg. Mar 2004;20(2):92-8. [Medline].

  15. Wong JF, Theriault JF, Bouzouaya C, et al. Marcus Gunn jaw-winking phenomenon: a new supplemental test in the preoperative evaluation. Ophthal Plast Reconstr Surg. Nov 2001;17(6):412-8. [Medline].

  16. Putterman AM. Jaw-winking blepharoptosis treated by the Fasanella-Servat procedure. Am J Ophthalmol. Jun 1973;75(6):1016-22. [Medline].

  17. Bullock JD. Marcus-Gunn jaw-winking ptosis: classification and surgical management. J Pediatr Ophthalmol Strabismus. Nov-Dec 1980;17(6):375-9. [Medline].

  18. Epstein GA, Putterman AM. Super-maximum levator resection for severe unilateral congenital blepharoptosis. Ophthalmic Surg. Dec 1984;15(12):971-9. [Medline].

  19. Dillman DB, Anderson RL. Levator myectomy in synkinetic ptosis. Arch Ophthalmol. Mar 1984;102(3):422-3. [Medline].

  20. Dryden RM, Fleming JC, Quickert MH. Levator transposition and frontalis sling procedure in severe unilateral ptosis and the paradoxically innervated levator. Arch Ophthalmol. Mar 1982;100(3):462-4. [Medline].

  21. Kersten RC, Bernardini FP, Khouri L, et al. Unilateral frontalis sling for the surgical correction of unilateral poor-function ptosis. Ophthal Plast Reconstr Surg. Nov 2005;21(6):412-6; discussion 416-7. [Medline].

  22. Islam ZU, Rehman HU, Khan MD. Frontalis muscle flap advancement for jaw-winking ptosis. Ophthal Plast Reconstr Surg. Sep 2002;18(5):365-9. [Medline].

  23. Lemagne JM. Transposition of the levator muscle and its reinnervation. Eye. 1988;2 (Pt 2):189-92. [Medline].

  24. Neuhaus RW. Eyelid suspension with a transposed levator palpebrae superioris muscle. Am J Ophthalmol. Aug 15 1985;100(2):308-11. [Medline].

  25. Tian N, Zheng YX, Zhou SY, Liu JL, Huang DP, Zhao HY. Clinical characteristics of moderate and severe Marcus-Gunn jaw-winking synkinesis and its surgical treatment. Zhonghua Yan Ke Za Zhi. Dec 2007;43(12):1069-72. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Marcus Gunn jaw-winking syndrome, Marcus Gunn jaw winking syndrome, Marcus Gunn jaw-winking ptosis, Marcus Gunn jaw winking ptosis, jaw-winking ptosis, jaw winking ptosis, ptosis, congenital ptosis, blepharoptosis, trigemino-oculomotor synkinesis, synkinetic jaw-winking phenomenon, wink reflex

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Sean M Blaydon, MD, FACS, Texas Oculoplastic Consultants, Austin, Texas
Sean M Blaydon, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, International College of Surgeons US Section, Pan-American Association of Ophthalmology, Pan-Pacific Surgical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.