Marcus Gunn Jaw Winking Phenomenon

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Rajamanickam CR et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-51 2017 244-246 244 IJAMSCR |Volume 5 | Issue 1 | Jan-Mar - 2017 www.ijamscr.com Case Report Medical research Marcus Gunn Jaw Winking Phenomenon Rajamanickam CR 1 Kannan R 2 PrasannaKarthik S 3 Vignesh Kumar 4 Swathi V 4 Jagadeesan M 5 1 Professor and Head Department of General Medicine MeenakshiAmmal Dental College and Hospital Chennai Tamilnadu India 2 Professor Department of General Medicine Saveetha Medical College Hospital Chennai Tamilnadu India 3 Associate Professor Department of General Medicine Saveetha Medical College Hospital Chennai Tamilnadu India 4 Resident Department of General Medicine Saveetha Medical College Hospital Chennai Tamilnadu India 5 Assistant Professor Department of General Medicine Saveetha Medical College Hospital Chennai Tamilnadu India Corresponding Author: Kannan R Email id: endorkyahoo.com ABSTRACT Marcus Gunn Jaw Winking Phenomenon MGJWP is a synkinetic phenomenon which can be congenital or acquired in certain cases presenting unilaterally or bilaterally and could also be present without ptosis. Patient usually adapts to it and surgical procedures are available for correction if debilitating. Her e we report a case of 20 year old male who was asymptomatic and was detected to have Marcus Gunn jaw winking phenomenon incidentally. Keywords: Marcus Gunn jaw winking phenomenon Marcus Gunn Jaw winking. INTRODUCTION Jaw Winking Phenomena is a synkinetic phenomenon which was first described by Robert Marcus Gunn called as Marcus Gunn jaw winking phenomenon MGJWP. Synkinesis is simultaneous movements of muscles supplied bydifferent nerves in a coordinated manner. MGJWP involves ptosis elevation and retraction of eyelids when the jaw moves during sucking and smiling. CASE REPORT A 20 year old male came to the Medicine outpatient department with complaints of burning micturition. On general examination the patient was found to have ptosis of right eye Fig 1. There was also elevation of the right upper eyelid on mouth opening Fig 2. Systemic examination was unremarkable. The patient had never sought any medical help for this. The patient was treated for ISSN:2347-6567 International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

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Rajamanickam CR et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-51 2017 244-246 245 UTI and the abnormal eyelid movements were evaluated. The visual acuity and extraocular movements were normal. Blink reflex cornea iris and pupils were normal. Other neurological examination was also normal. Investigations including MR Brain were also within normal limits. Fig 1: Partial ptosis of the right eye Fig 2: Elevation of the right eyelid with opening of the mouth DISCUSSION MGJWP was first described by an ophthalmologist Robert Marcus Gunn in 1883.It was thought to be due to misdirection of axons of trigeminal nerve which were intended to travel and innervate the pterygoid but aberrantly innervating

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Rajamanickam CR et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-51 2017 244-246 246 the levatorpalpabraesuperioris muscle which is usually supplied by the oculomotor nerve. MGJWP is due to neurogenic atrophy along with aberrant innervations. It is usually a bilateral process with one lid affected more than the other 1 2. The etiology probably starts in utero with pathology in the brain stem than the peripheral nerve fibres. MGJWP does not have any relation to preterm gestational age as full term babies with MGJWP also have been described. MGJWP was thought to be a congenital syndrome associated with ptosis adduction and retraction defects but cases with no ptosis and retraction defects and isolated adduction defects have also been reported. An acquired case of MGJWP in 65 old male due to diabetes has also been described with the winking reducing after achieving good glycemic control. 3 When present congenitally it is mostly sporadic in nature. Severity of the wink is assessed by the covering of the upper eyelid over the cornea which is around 1mm normally. It is mild when the coverage is less than 2mm moderate when it is between 2 and 5 mm and severe when more than 6mm 4. MGJWP is associated with strabismus 36 Double elevator palsy 25 Superior rectus plasy 36 Ambylopia 34-59 cleft lip / palate CHARGE syndrome Renal Calculi and Duane Syndrome 5. Other ocular synkineic syndromes include Marin Amat syndrome and Inverse Marcus Gunn syndrome in which there is falling of eye lids on mouth opening as there is inhibition of levator muscle 1. Various surgical options are available for MGJWP which includes bilateral frontalis suspension with unilateral levator excision and frontalis sling repair. Usually surgery is needed for severe cases alone as the mild cases improves with time as the person learns to recognize and adapts movements to minimize and mask the wink 6. REFERENCE 1. Balaban H Yildiz OK Eliaçik S Bolayir E Topaktaş S. A case with a rare type of trigemino - oculomotorsynkinesis: clinical and blink reflex study. ActaNeuro Belg.110 2010 337-9 2. Duke-Elder S. Normal and abnormal development: congenital deformities. In: System of Ophthalmology. St. Louis Mosby 900 1963 5. 3. Dutta D Maisnam I Ghosh S Mukhopadhyay P Mukhopadhyay S Chowdhury S.Marcus-Gunn Jaw Winking Syndrome and Gustatory Sweating in Long Standing Poorly Controlled Diabetes: A Case Report. Int J Clin Med. 3 2012 40-42 4. Demirci H Frueh BR Nelson CC. Marcus Gunn jaw winking synkinesis: clinical features and management. Ophthalmology 1177 2010 1447-52. 5. Torres MRF Calixto Jr. N Oliveira LR Steiner SA Iscold AM. Marcus Gunn Phenomenon: differential diagnosis of palpebral ptoses in children. Jornal de Pediatria. 803 2004 249-52. 6. Liu R Hu WK Li B Xiang N. Management of morderate-to-severe Marcus-Gunn syndrome by anastomosis of levator and frontal muscles. Int j ophthalmol 34 2010 342-5 How to cite this article: Rajamanickam CR Kannan R PrasannaKarthik S Vignesh Kumar Swathi V Jagadeesan M. Marcus gunn jaw winking phenomenon. Int J of Allied Med Sci and Clin Res 2017 51: 244-246. Source of Support: Nil.Conflict of Interest: None declared.

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