Wong J F, Thériault J F, Bouzouaya C, Codère F
Department of Ophthalmology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Ophthalmic Plast Reconstr Surg. 2001 Nov;17(6):412-8. doi: 10.1097/00002341-200111000-00005.
To introduce a new method for the evaluation of Marcus Gunn jaw-winking ptosis that more precisely defines the severity of blepharoptosis.
A retrospective review of 16 consecutive patients with Marcus Gunn jaw-winking ptosis presenting to our institution between 1993 to 1999 was performed. The position of the affected eyelid was observed after applying a technique of jaw immobilization and disruption of fusion with temporary occlusion of the ipsilateral side.
In patients presenting with mild to moderate Marcus Gunn jaw-winking, the majority (62.5%) demonstrated a positive test, uncovering complete or near complete ptosis. Test results were partially positive in 3 patients (18.8%) with increased but not complete ptosis and negative in 3 patients (18.8%) with no change in eyelid position.
Blepharoptosis associated with Marcus Gunn jaw-winking phenomenon is often more severe than found by conventional clinical evaluation. This finding may explain the frequent undercorrection and unpredictable results following levator resection. In patients exhibiting a positive jaw-winking ptosis test, disappointing outcomes with levator resection may be avoided by instead proceeding with a frontalis suspension with levator disinsertion as recommended for ptosis with severe jaw winking.
介绍一种评估Marcus Gunn 氏下颌瞬目性上睑下垂的新方法，该方法能更精确地界定上睑下垂的严重程度。
对1993年至1999年间连续收治于我院的16例Marcus Gunn氏下颌瞬目性上睑下垂患者进行回顾性研究。应用下颌固定技术并通过暂时遮挡患侧来破坏融合后，观察患侧眼睑的位置。
在轻度至中度Marcus Gunn氏下颌瞬目性上睑下垂患者中，大多数（62.5%）试验呈阳性，显示完全或近乎完全上睑下垂。3例患者（18.8%）试验结果部分阳性，上睑下垂有所加重但未完全下垂，3例患者（18.8%）试验结果为阴性，眼睑位置无变化。
与Marcus Gunn氏下颌瞬目现象相关的上睑下垂通常比传统临床评估所发现的更为严重。这一发现可能解释了提上睑肌切除术之后经常出现的矫正不足和不可预测的结果。在表现出阳性下颌瞬目性上睑下垂试验的患者中，按照重度下颌瞬目性上睑下垂的推荐方法，采用提上睑肌离断的额肌悬吊术，可能避免提上睑肌切除术令人失望的结果。
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