Surgical Outcomes of Unilateral Marcus Gunn Jaw Winking Ptosis Correction: A Novel Whitnall’s Ligament Approach

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In ptosis, the upper eyelid drops lower than the normal position in primary gaze.In severe ptosis upper lid may drop below the pupilary plane and cover the pupil partially or completely which may cause visual obstruction.Especially in children, this constant visual deprivation leads to the development of the amblyopia.The congenital blepharoptosis cases are almost 50% [1,2].In 1883, a peculiar congenital ptosis associated with the winking motion of the upper eyelid was observed by Robert Marcus Gunn.It was a 15-year-old girl.This synkinetic jaw winking phenomenon is now known as Marcus Gunn Purpose: To evaluate the surgical, functional, and cosmetic outcome in moderate to severe ptosis with Marcus Gunn jaw winking phenomenon and recurrence of disease after ptosis correction.This procedure has been emphasized on a child.Methods: This was a prospective, non-comparative, interventional study conducted over 4 years on 30 people.The ages range from 7 to 40 years.The eyelid was approached from behind to identify the Whitnall's ligament.Levator palpebrae superioris was first disinserted then dissected up to the superior border of the tarsal plate followed by 20 to 25 mm by resection which causes disabling of the levator palpebrae superioris action.Subsequently, "tarso frontalis sling with silicon rod" for ptosis correction.Compared with the preoperative and postoperative photograph.Results: Margin reflex distance 1 values are in the affected eye preoperative 1.8 ± 0.87 mm to postoperative 3.96 ± 0.41 mm.Preoperative palpebral fissure height are means 5.05 ± 0.62 mm to postoperative palpebral fissure height means 9.3 ± 0.71 mm.Ptosis significantly improved which is statistically significant (p < 0.05).Lid excursion or Flickering's in affected eyes preoperative means 6.1 ± 3.47 mm to postoperative after 1 year means are 0.43 ± 0.81 mm.Follow-up period is 1 year.Conclusions: Unilateral posterior approach (Whitnall's ligament approach) is found better in surgical, functional, and cosmet- ic outcomes in the correction of Marcus Gunn jaw winking syndrome, especially in children.The risk of bilateral extensive surgery is avoided.After the surgery, the primary gaze face photo identity was well-accepted in official government documents.This study is stressed on bilateral lid height similarity in primary gaze unlike the traditional method of downgaze similarities.The patients were highly satisfied both physically and mentally.

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