Bilateral levator muscle myotomy and frontalis muscle advancement flap in treatment of unilateral Marcus-Gunn jaw winking ptosis

Abstract

Aim The aim of this study was to report the experience of performing bilateral levator disinsertion followed by bilateral frontalis sling among patients having unilateral Marcus-Gunn jaw winking and ptosis (MGJWP). Setting and design This is a retrospective study that was conducted at Elsafwa Eye Centre, Alexandria, Egypt. Patients and methods The medical records of 24 patients with significant unilateral MGJWP were retrospectively reviewed. Full ophthalmological examination included external eye examination, extraocular muscle motility testing, best-corrected visual acuity, margin reflex distance (MRD) in mm, levator muscle excursion in mm, and amount of jaw winking in mm. All patients in the study had significant winking phenomenon. Bilateral levator disinsertion followed by bilateral frontalis sling was performed. Postoperatively, the patients were examined for MRD in both eyelids, amount of wink, degree of lagophthalmos, eyelid contour, patient satisfaction, and presence of complications or undercorrection. Results More than 2 mm of winking was considered cosmetically unacceptable to the patient and/or the parents. Postoperative follow-up periods ranged from 6 to 52 months, with an average of 16.9 months. After bilateral levator myotomy and bilateral frontalis advancement flap, 22 eyelids (91.66%) showed complete resolution of jaw winking and 2 eyelids (8.33%) showed mild winking (2 mm or less). Surgery was redone in two patients (8.33%) for undercorrected ptosis after 6 months of follow-up, whereas two patients (8.33%) had contour problem in the operated ptotic eyelid. All patients had immediate postoperative lagophthalmos that totally resolved in all patients after 6-month follow-up. Conclusion Bilateral levator muscle disinsertion followed by bilateral frontalis suspension using frontalis muscle advancement flap is an effective surgical technique for the treatment of unilateral MGJWP, resulting in satisfactory symmetrical outcome and resolution of jaw winking and ptosis in most of the cases.