Marcus Gunn jawwinking ptosis

Marcus Gunn jaw-winking ptosis is a developmental abnormality where the levator muscle co-contracts with stimulation of the trigeminal nerve supply to lateral pterygoid, medial pterygoid or both. Autosomal dominantly inherited or sporadic.

There is ptosis of varying severity with related degree of levator function often associated with superior rectus underaction. Movement of the jaw causes elevation of the upper lid i.e. the wink.

Abolition of the wink requires division of the levator muscle and subsequent brow suspension (unilateral, bilateral or levator transposition). Treatment of the ptosis alone should err towards undercorrection if there is a risk of post operatively accentuating the wink by exposing more sclera.

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