An Alternative Surgical Approach for Marcus Gunn Jaw Wink Ptosis
Karen Revere, MD; Akusoa Nti, MD; William R. Katowitz, MD; James A. Katowitz, MD; Gil Binenbaum, MD, MSCE
Children’s Hospital of Philadelphia
Introduction: Traditional management for unilateral Marcus Gunn jaw wink ptosis (MGJWP) is levator extirpation and bilateral frontalis suspension. We sought to determine whether unilateral ptosis surgery without extirpation results in good outcomes in children with MGJWP.
Methods: A retrospective cohort study of children undergoing ptosis surgery for MGJWP without levator extirpation was done over 6 years at Children’s Hospital of Philadelphia. The primary outcome was a successful post-operative result, satisfying all of the following criteria: (1) parent and surgeon satisfaction in appearance of lid height and jaw wink, (2) functional ptosis success (MRD1>/=2mm), (3) no subsequent extirpation necessary. Additional outcomes were further surgery and complications.
Results: 32 children were studied, mean age at first surgery 2.6 years (0.1-16.8), mean follow-up 30.7 months (1.2-182). All children had unilateral surgery. Initial procedures were frontalis suspension (n=12), levator advancement/resection (n=12), and modified Fasanella-Servat (n=8). 88% had a successful post-operative result, meeting all 3 primary outcome criteria. 63% achieved a successful outcome after one procedure, 24% after two procedures. 4 children had persistent jaw wink, and two underwent secondary levator extirpation. One child developed a hypertrophic scar, and 3 mild post-operative exposure keratopathy treated with lubrication.
Discussion: Unilateral ptosis surgery without levator extirpation for MGJWP is an effective and less aggressive surgical approach that can be used as an initial surgical option with appropriate counseling that a minority of children may require secondary extirpation.
Conclusion: Unilateral ptosis surgery without extirpation can treat Marcus Gunn jaw wink ptosis with a very high success rate.
References: Pearce FC, McNab AA, Hardy TG. Marcus Gunn Jaw-Winking Syndrome: A Comprehensive Review and Report of Four Novel Cases. Ophthal Plast Reconstr Surg. 2017 Sep/Oct;33(5):325-328.