Surgical Outcomes of Unilateral Marcus Gunn Jaw Winking Ptosis Correction: A Novel Whitnall's Ligament Approach

Abstract

Purpose: To evaluate the surgical, functional, and cosmetic outcome in moderate to severe ptosis with Marcus Gunn jaw winking phenomenon and recurrence of disease after ptosis correction. This procedure has been emphasized on a child.

Methods: This was a prospective, non-comparative, interventional study conducted over 4 years on 30 people. The ages range from 7 to 40 years. The eyelid was approached from behind to identify the Whitnall's ligament. Levator palpebrae superioris was first disinserted then dissected up to the superior border of the tarsal plate followed by 20 to 25 mm by resection which causes disabling of the levator palpebrae superioris action. Subsequently, "tarso frontalis sling with silicon rod" for ptosis correction. Compared with the preoperative and postoperative photograph.

Results: Margin reflex distance 1 values are in the affected eye preoperative 1.8 ± 0.87 mm to postoperative 3.96 ± 0.41 mm. Preoperative palpebral fissure height are means 5.05 ± 0.62 mm to postoperative palpebral fissure height means 9.3 ± 0.71 mm. Ptosis significantly improved which is statistically significant (p < 0.05). Lid excursion or Flickering's in affected eyes preoperative means 6.1 ± 3.47 mm to postoperative after 1 year means are 0.43 ± 0.81 mm. Follow-up period is 1 year.

Conclusions: Unilateral posterior approach (Whitnall's ligament approach) is found better in surgical, functional, and cosmetic outcomes in the correction of Marcus Gunn jaw winking syndrome, especially in children. The risk of bilateral extensive surgery is avoided. After the surgery, the primary gaze face photo identity was well-accepted in official government documents. This study is stressed on bilateral lid height similarity in primary gaze unlike the traditional method of downgaze similarities. The patients were highly satisfied both physically and mentally.

Keywords: Blepharoptosis; Blinking; Marcus Gunn phenomenon.

Fig. 1

Steps of surgical procedure of Marcus Gunn jaw winking ptosis correction. (A) Upper lid crease incision made 6 to 7 mm from the upper border of the lid match to the opposite site. (B) Levator palpebrae superioris is lifted from the underling conjunctiva by lens hook dissected up to the superior border of tarsal plate. (C) Supratarsal skin, muscle complex is intact for silicon rod anchoring. (D) Stretched levator palpebrae superioris excised at the upper border of tarsal plate. (E) Fox pentagon procedure with silicon rod. (F) Wound repair with 5-0 black silk. Written informed consent was obtained from the patients for publication of the clinical images.

Fig. 2

Preoperative image of patient with Marcus Gunn jaw winking syndrome. (A) Showing preoperative jaw winking phenomenon with jaw movement. (B) Showing preoperative jaw winking phenomenon with jaw movement. Wriiten informed consent was obtained from the patient for publication of these clinical images.

Fig. 3

Postoperative image of patient with Marcus Gunn jaw winking syndrome. (A) Showing postoperative no jaw winking phenomenon with the movement of the jaw. (B) Showing postoperative no jaw winking phenomenon with jaw movement. Wriiten informed consent was obtained from the patient for publication of these clinical images.

Fig. 4

Showing the comparison of preoperative and postoperative vertical palpebral fissure height among the study population (n = 30).

Fig. 5

Showing the comparison of preoperative and postoperative margin reflex distance 1 among the study population (n = 30).

Fig. 6

Showing the comparison of preoperative and postoperative flickering among the study population (n = 30).