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Table 2. Included peer-reviewed articles on surgical management of Marcus-Gunn jaw-winking synkinesis
Sample
Author(s) Year Ptosis severity Management Outcome
size
Beard [25] 1965 1 Severe Levator excision of the unaffected This approach is recommended for
eyelid followed by bilateral brow a failed prior surgery. Resulted in
suspension satisfactory outcomes
Nagpaul and Charan [26] 1968 1 5 mm Motais-Parinaud procedure Moderate improvement shown after
the operation. Paretic superior rectus
did not improve
Tsai et al. [27] 2002 1 Severe Orbicularis oculi muscle flap Used the orbicularis oculi muscle
flap to elevate dynamically the ptotic
eyelid and to eliminate the synkinetic
reflex without levator excision. This
approach had successful outcomes
Yoshikata and Yanai [28] 1999 1 Severe Unilateral excision of levator muscle 33-yr-old patient had satisfactory
followed by unilateral frontalis surgical outcomes
suspension
Carbajal [18] 1959 5 N/A A case-by-case approach: levator Except for one case, all patients
tucking, Blaskovics, tenectomy and experienced recurrence between 6
Friedenwald-Guyton, tenectomy and and 23 months
Reese
Bajaj et al. [15] 2015 10 4.25 ± 0.79 Levator plication 10 patients underwent modified
mm levator plication surgery. 9 patients
showed correction of ptosis and 3
had resolution of MGJWS. Resolution
of MGJWP was defined as less than 1
mm of excursion of upper eyelid with
synkinetic mouth movement. Ptosis
correction (2.40 ± 0.50 mm) was
statistically significant
Betharia and Kumar [14] 1987 15 Severe (n = 9); Unilateral levator transection with Good correction in 10 cases. Under-
mild-moderate levator aponeurosis for frontalis correction in 5 cases
(n = 6) suspension (Neuhaus/Lemagne
method)
Bartkowski et al. [29] 1999 19 Marked (n = Unilateral levator transection with 84% patients showed no symptoms
15) levator aponeurosis for frontalis after the surgery. 1 patient had
suspension (Neuhaus/Lemagne lagopthalmos
method; n = 16); unilateral levator
transection followed by unilateral
frontalis suspension (n = 3)
Park et al. [30] 2008 20 Mild-moderate Unilateral levator resection only After ~30 months, blepharoptosis
ptosis (n = 10); frontalis muscle flap or was corrected; however, there was
orbicularis oculi muscle flap (n = 10) only mild to moderate resolution of
jaw-winking reflex
Shah et al. [31] 2019 23 Moderate to Unilateral tarsofrontal silicone sling Unilateral tarsofrontal silicone sling
severe without levator excision without disinsertion or extirpation
of the levator reduces the severity
of symptoms in MGJWS. “good” =
upper eyelid height was <1 mm, “fair”
= 1-2 mm and “poor”≥ 2 mm
Khwarg et al. [19] 1999 24 Minimal (n = Bilateral (n = 19) or unilateral (n = The procedure provides satisfactory
5); 5) levator excision, all followed by correction (62% cases). But 5
moderate (n = bilateral frontalis suspension patients reported recurrence
11); severe (n =
9)
Bowyer and Sullivan [13] 2004 31 Severe (n = Unilateral levator advancement The surgical approach will differ
10); mild- surgery (n = 4, mild cases); bilateral according to the condition. Patients
moderate (n = levator weakening followed by with bilateral surgery had wink
21) bilateral frontalis suspension (n = 13, elimination while unilateral surgery
moderate-severe cases) had detectable wink
Ning et al. [32] 2019 42 Mild (n = 7); Unilateral levator excision followed 34 patients with moderate to severe
moderate (n = by unilateral frontalis suspension MGJWS underwent surgery and had
24); severe (n satisfactory outcomes at 6-month
= 11) follow-up
Demirci et al. [16] 2010 48 Mild (n = 8); Unilateral levator excision followed The management was effective.
moderate (n = by bilateral/unilateral frontalis Symptoms resolved in 97% patients
36); severe (n suspension and improved in 3%
= 4)