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Ophthalmology

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Eyelid

Question
12 out of 17
 

Patient with non retractable ptosis gets corrected due to actions like minking, chewing (AIPG 2010)



A abducent nerve palsy

B 3 rd nerve palsy

C Marcuss gun jaw winking syndrome

D None of these

Ans. C Marcuss gun jaw winking syndrome* Ref. Kanski, Page 136-138

Marcus Gunn Jaw-winking syndrome

The vast majority of cases are unilateral. That a branch of the mandibular division of the fifth cranial nerve is misdirected to the levator muscle. Now believed to be synkinesis.

Signs:

1. Retraction of the ptotic lid in conjunction with stimulation of the ipsilateral pterygoid muscles by chewing, sucking, opening the mouth or contralateral jaw movement.

Treatment:

1. Surgery should be considered if jaw-winking or ptosis represents a significant functional or cosmetic problem.

2. About 5% of all causes of congenital ptosis manifest the Morus-Gunn jaw winking of phenomenon. The vast majority of causes one unilateral. It has been postulate & that mandibular division of 5th cranial name is misdirected to levator muscle.

Rx –

1. Unilateral levator resection with fromntalis sling

2. Unilateral levator with fromntalis sling

3. B/L levator disinsertion with fromntalis sling

Option-

1. 4th nerve palsy (superior oblique plary)

a. Inability to look inferomedially

b. Diplopia on looking down (difficulity in climbing down)

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