Successfully Modified Dillman-Anderson Myectomy for Marcus Gunn Jaw Winking Ptosis Repair: A Case Report

Abstract

Introduction: Marcus Gunn jaw winking ptosis (MGJWP) is a type of ptosis present from birth which is characterized by winking of the ptotic eyelid during jaw movement. Case illustration: A 6-years-old child came with a complaint of a right eyelid drooping since birth. The eyelid droop was not progressive. Patient had difficulty to read at a distance, since two years ago. The eyelids moved when the patient chews, sucks, or moving jaw from side to side. Examination did not demonstrate any apparent ptosis of either eyelid nor the movement of eyelids when chewing. On examination of ptosis status on right/left eye, MRD1:0/3, MLD:1/5,LA:4/12 and FIP:6/10.Modified Dillman and Anderson’s myectomi with removal of levator muscle above whitnall’s ligament followed by frontalis suspension using autogenous fascia lata was performed successfully on this patient. Discussion: MGJWP is ptosis in one eye since birth which causes the ptosis eyelid to wink due to provocation of the same side pterygoid muscle. The jaw winking movement is caused by mouth movements such as opening, moving the mouth to the right and left, chewing and sucking. Modified Dillman and Anderson's myectomi with removal of levator muscle followed by frontalis suspension was chosen because it has a better outcome. In the postoperative period, there were no more complaints of ptosis and the jaw winking was resolved. Serious postoperative complications of this surgical technique such as entropion, worsening jaw winking and exposure keratopathy were not found. Conclusion: For severe MJGWP , Modified Dillman and Anderson’s myectomy technique gives satisfactory results in both ptosis correction and jaw winking without serious complications.