Marcus Gunn Jaw-Wink Syndrome
A congenital ptosis in which the eyelid lifts when the jaw moves — an abnormal connection between the chewing and eyelid-lifting nerves.
Marcus Gunn Jaw Wink
Marcus Gunn jaw-wink ptosis is an example of synkinesis — an abnormal neural connection between two muscle groups that are normally unrelated. A branch of the trigeminal nerve (CN V, which supplies the pterygoid jaw muscles) misdirects into the branch of the oculomotor nerve (CN III) that lifts the upper eyelid. The result: the ptotic lid rises whenever the jaw opens or moves laterally.
Marcus Gunn Jaw Wink
Slide the control to move the mouth.
Use the slider in the animation above to simulate the jaw-wink synkinesis — the eyelid rising as the jaw opens.
Key Features
- Occurs in 2–13% of patients with congenital ptosis
- Levator function is typically poor (≤ 4 mm)
- Does not improve spontaneously, though children learn to minimize visible jaw movement over time
- Associated strabismus in ≈ 60%, amblyopia in ≈ 35%
Treatment
The surgical approach is guided by the severity of both the ptosis and the jaw-wink:
- Mild jaw-wink with significant ptosis: unilateral frontalis sling may achieve acceptable symmetry
- Significant jaw-wink: bilateral levator muscle disinsertion followed by bilateral frontalis sling — this eliminates the synkinesis entirely and allows symmetrical correction
Frequently Asked Questions
- What is the Marcus Gunn jaw-wink?
- A congenital miswiring in which the nerve to a chewing muscle is abnormally linked to the eyelid-lifting muscle, so the droopy lid 'winks' upward when the jaw moves or the baby suckles.
- How is it treated?
- Mild cases need no surgery. When the jaw-wink or the ptosis is significant, surgery weakens the abnormal levator link and supports the lid (often with a frontalis sling) to give a stable, natural lid position.
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