Jaw winking

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Jaw winking (Marcus Gunn phenomenon*) is an aberrant innervation syndrome that occurs when congenital ptosis is associated with abnormal communications between CN V and the levator palpebrae.(1-4) The ptotic lid opens and sometimes retracts when the mouth opens, with chewing or when the jaw is moved side to side (Video). When the jaw opens or moves laterally the lid pops open, when the jaw closes the lid winks closed. Jaw winking is considered a trigemino-oculomotor synkinesis due to misdirection of proprioceptive impulses from the pterygoid muscles to the oculomotor nucleus, and occurs in 2-13% of patients with congenital ptosis.1 In inverse jaw winking, the lid closes on opening the mouth.

Marin Amat sign is another condition in which the eye closes with mouth movements. It is a type of facial synkinesia due to facial nerve aberrant innervation causing eye closure with smiling or mouth opening. It occurs most often following Bell’s palsy with poor recovery and a profusion of misdirected axons from lower facial muscles to the orbicularis oculi. For an example see facial synkinesis at www.neurosigns.org.

A number of videos have been posted on the Internet of jaw-winking; here is an especially dramatic example

  • for R. Marcus Gunn, Scottish ophthalmologist

Video courtesy of Dr. Stephen Reich, University of Maryland

References

References

1. Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

2. Carman, KB, Ozkan, S, Yakut, A, et al. Marcus Gunn jaw winking synkinesis: report of two cases. BMJ Case Rep. 2013 Jan 23; 2013.

3. Pearce FC, McNab AA, Hardy TG. Marcus Gunn Jaw-Winking Syndrome: A Comprehensive Review and Report of Four Novel Cases. Ophthal Plast Reconstr Surg. 2016 Sep 7. [Epub ahead of print]

4. Falcão I, Almeida F. Marcus Gunn Phenomenon. J Pediatr. 2017;188:302