Bowyer Jeremy D, Sullivan Timothy J
Eyelid, Lacrimal, and Orbital Clinic, Division of Ophthalmology, Department of Surgery, Royal Brisbane Hospital, Herston, Brisbane, QLD, Australia.
Ophthalmic Plast Reconstr Surg. 2004 Mar;20(2):92-8. doi: 10.1097/01.iop.0000115595.20838.f4.
To report the outcomes of a management protocol for Marcus Gunn jaw winking synkinesis.
The records of 31 patients (16 female, 15 male) presenting to a tertiary referral center with Marcus Gunn jaw winking synkinesis between 1993 and 2003 were retrospectively analyzed. Generally, patients with mild wink and a small degree of ptosis underwent unilateral upper eyelid retractor surgery. Patients with a moderate or marked wink and ptosis underwent bilateral levator weakening procedures and brow suspension. Patients were assessed and treated for amblyopia and vertical strabismus before ptosis surgery.
Mean patient age was 11.23 years (median, 8 years; range, 10 weeks to 31 years). Ipsilateral hypotropia was noted in 8 patients (26%), with a median visual acuity in the ptotic eye of 20/30 (range, 20/20 to 20/40), compared with 20/20 in those without hypotropia. Patients who underwent unilateral surgery had good correction of ptosis, with equal palpebral apertures and symmetrical contour but had a detectable wink on formal testing. Patients who underwent bilateral surgery had equal palpebral apertures and symmetrical contour, with wink elimination. Mean follow-up was 31 months (all patients) and mean postoperative follow-up was 22 months.
Patients with Marcus Gunn jaw winking synkinesis can present at a wide age range. There may be an associated vertical muscle imbalance, which should be managed before ptosis surgery to avoid ptosis undercorrection and allow amblyopia management. Nearly all patients use the synkinesis to reduce the underlying true ptosis to a less noticeable "habitual" ptosis or to maintain binocularity. Surgical approach will differ, depending on whether the synkinesis, ptosis, or both are the main concern. Satisfactory results with a low complication rate can be achieved with the use of this management protocol.
报告一种针对Marcus Gunn眼睑-下颌联动综合征的治疗方案的效果。
回顾性分析1993年至2003年间在一家三级转诊中心就诊的31例（16例女性，15例男性）患有Marcus Gunn眼睑-下颌联动综合征患者的病历。一般来说，轻度眨眼且上睑下垂程度较轻的患者接受单侧上睑提肌手术。中度或重度眨眼及上睑下垂的患者接受双侧提上睑肌减弱手术和眉悬吊术。在进行上睑下垂手术前，对患者进行弱视和垂直斜视的评估及治疗。
患者平均年龄为11.23岁（中位数8岁；范围10周至31岁）。8例患者（26%）存在同侧下斜视，上睑下垂眼的中位视力为20/30（范围20/20至20/40），而无下斜视的患者视力为20/20。接受单侧手术的患者上睑下垂得到良好矫正，睑裂相等且外形对称，但在正式检查时仍可检测到眨眼。接受双侧手术的患者睑裂相等且外形对称，眨眼消失。平均随访时间为31个月（所有患者），术后平均随访时间为22个月。
Marcus Gunn眼睑-下颌联动综合征患者的发病年龄范围较广。可能存在相关的垂直肌失衡，应在进行上睑下垂手术前进行处理，以避免上睑下垂矫正不足并便于弱视治疗。几乎所有患者利用联动来将潜在的真性上睑下垂减轻至不太明显的“习惯性”上睑下垂，或维持双眼视觉。手术方法将因联动、上睑下垂或两者是否为主要问题而有所不同。采用该治疗方案可获得满意的效果且并发症发生率较低。
