Brown syndrome with Marcus-Gunn jaw-winking phenomenon and ptosis: distinct entities or a part of the congenital cranial dysinnervation spectrum?
Vaishali Tomar, Mittali Khurana, Aakanksha Raghuvanshi et al.
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Case in brief
An 8-year-old girl presented with right-eye motility restriction, ptosis, and eyelid movement linked to jaw movement. Examination showed right hypotropia and limited elevation in adduction, consistent with Brown syndrome. The ptosis resolved when she opened or moved her jaw, consistent with Marcus-Gunn jaw-winking syndrome. The report describes these findings as coexisting in the same eye, combining a mechanical motility restriction with congenital synkinesis.
What made this case unusual
The notable feature was the ipsilateral combination of Brown syndrome, Marcus-Gunn jaw-winking syndrome, and ptosis in a child; the authors identify it as the first pediatric report of this combination.
Diagnostic / clinical pearl
Assess ocular motility and eyelid position during jaw movement: restricted elevation in adduction and jaw-linked eyelid elevation can indicate coexisting Brown syndrome and Marcus-Gunn jaw-winking syndrome.
Why it matters
The coexistence of mechanical restriction and dysinnervation highlights the complexity of congenital cranial dysinnervation disorders and the value of thorough clinical evaluation.