Marcus-Gunn jaw-winking ptosis: classification and surgical management.

Twenty patients with the Marcus-Gunn jaw-winking ptosis phenomenon have been examined. These patients have been classified according to the degree of two parameters: ptosis and jaw-winking. A 3 X 3 matrix has been constructed which gives nine combinations of ptosis (mild, moderate, severe) and jaw-winking (mild, moderate, severe). The rationale for this matrix is given and the surgical procedure advocated for each position is detailed. The operation advocated by Beard for the correction of jaw-winking ptosis has been modified in the following ways: (1) The levator muscle on the jaw-winking side is excised from the tarsal attachments to the orbital apex. This almost totally eliminates the jaw-winking. (2) An upper eyelid blepharoplasty is performed on the jaw-winking side to remove the excess skin. This prevents an overhang of skin following the frontalis sling portion of the operation.