Marcus Gunn jaw-winking syndrome.

From the Department of Neurology, Chia-Yi Christian Hospital, Chia-Yi. Received June 24, 2009. Revised and Accepted July 10, 2009. Reprint requests and correspondence to: Yu-Hisang Su, MD. Department of Neurology, Chia-Yi Christian Hospital, No 539, Chung-Shao Road, Chia-Yi, Taiwan. E-mail: [email protected] KT is a 3-year-old girl and presents with a significant left congenital ptosis. Since birth, her parents observed that her ptosis dramatically subsides almost completely when she was chewing, sucking, or opening her mouth. Sometimes the ptosis becomes worse during downward gaze. She has normal developmental milestone without history of other ocular problems, and was otherwise well. There was no family history of similarly affected individuals. Examination showed that her pupils are isocoric (3mm/3mm) with normal light reflex. Her visual acuities and visual field are normal. She had a 3-4 mm left ptosis, with typical Marcus Gunn syndrome: the eyelid elevates to the normal position when her jaw is opening. All extra-ocular movements are normal and the neutral positions of eyeballs are central. Other neurological examinations are normal. Magnetic resonance imaging of brain including diffusion tensor color map is normal. Her family concerned about the cosmetic appearance of the ptosis and planned to arrange plastic surgery in the future. Marcus Gunn f irst decribed this particular jawwinking syndrome in 1883. It accounts for approximately 5% of all cases of congential ptosis with various degrees. It is usually unilateral, but can present bilaterally in rare cases. Most patients with Marcus Gunn jawwinking syndrome are identifed soon after birth by their own parents during feeding because of its typical phenomenon. When the baby or child is opening his or her mouth, sucking or chewing, the ptotic upper eyelid elevates to an equal or even higher level than the contralateral normal eyelid. Other movement with activation of ipsilateral lateral pterygoid muscle could also lead to 76