This is a review of 72 cases of Marcus-Gunn jaw winking syndrome. The authors reviewed all their congenital ptoses seen over a 16-year period and found 72 Marcus-Gunn cases out of a total of 848 patients. Within the 72 they identified four patients who had no ptosis, but only lid retraction on jaw movement. One of these had a unilateral ptosis but bilateral jaw winking. The same patient also had a left esotropia on mouth opening displaying synkinesis of both the levator and medial rectus with lateral pterygoid contraction. This particular phenomenon has not been reported before, and only one previous case of Marcus-Gunn jaw-winking without ptosis has ever been reported. The authors described four cases equating to 6% of all Marcus-Gunn patients in their series. They suggest it may be more common than previously thought as patients without ptosis may not seek medical help and remain undiagnosed in the general population. The article also reviews the current understanding of the aetiology of the condition, which remains under debate. Conservative management is recommended given that intervention to treat the wink is likely to result in greater asymmetry. This is an interesting paper with new findings. 

Marcus Gunn jaw-winking syndrome: a comprehensive review and report of four novel cases.
Pearce FC, McNab AA, Hardy TG.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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