Treatment of Marcus Gunn Jaw Winking Ptosis

Objective To share the experience of treating Marcus Gunn jaw winking ptosis by levator disinsertion followed by frontalis sling procedure. Study design Case series.  Place & Duration of study Oculoplastic Department,  Khalid eye clinic Karachi, from May 2019 to October 2019.  Methodology Patients of unilateral congenital Marcus Gunn jaw winking ptosis of both genders with an age range of 9 to 15 years were enrolled. Levator disinsertion followed by frontalis sling procedure was performed in all cases. The inclusion criteria for undergoing levator muscle disinsertion followed by frontalis sling comprised of drooping of the eyelid (ptosis) of greater than 2mm with moderate to severe jaw winking of the affected eye. The rectification of ptosis, eyelid equilibrium, improvement of winking and postoperative complications were assessed. A successful surgical outcome was classified as jaw winking of less than 1mm of affected eyelid with synkinetic jaw movement. Postoperative follow up period was of three months. Approval of ethical review committee and informed consent were obtained from the parents.  Results Marcus Gunn jaw winking ptosis was more common in females. Ten out of eleven patients had excellent cosmetic outcome comparable to the contralateral eye at the end of follow up period of three months. Residual jaw winking was only seen in one patient despite good ptosis correction.  Conclusion Levator disinsertion followed by frontalis sling is an excellent technique for the rectification of ptosis and Marcus Gunn jaw winking phenomenon.  Key words Marcus Gunn jaw winking, Ptosis, Frontalis sling, Levator disinsertion.