The Clinical Study On the Surgical Methods of Synkinetic Ptosis Treatment.

Sohn, Mi A; Lee, Tae Soo

Original Article

Journal of the Korean Ophthalmological Society 1989;30(3):429-435.
Published online March 1, 1989.

The Clinical Study On the Surgical Methods of Synkinetic Ptosis Treatment.

Mi A Sohn, Tae Soo Lee

Department of Ophthalmology, School of Medicine, Korea University, Seoul, Korea.

Synkinetic ptosis 의 수술적 요법에 대한 임상적 고찰

손미아(Mi A Sohn),이태수(Tae Soo Lee)

Abstract

Synkinetic ptosis refers to abnormal vertical movement of upper eyelid. This abnormal elevation of the eyelid results from opening or closing of the mouth, chewing, sucking, and movement of jaw outward or toward the contralateral side. A number of other stimuli for the phenomenon have been described. These include smile, sternocleidomastoid contraction or tongue protrusion, inspiraion, and voluntary nystagmus. This type of ptosis was most commonly seen with a congenital Marcus-Gunn jaw-winking syndrome. Usually this movement is thought to be due to a congenital misdirection of some of the 5th cranial nerve fibers into the branch of the 3rd cranial nerve that supplied the levator muscle. We experienced 6 cases of synkinetic ptosis, among them, interesting enough, one was typical elevation of upper lid in smile due to misdirection between the oculomotor and facial nerve fibers. The cosmetic problem was the first purpose of the surgery. So, we performed a levator extirpation with frontalis suspension on 4 cases who had the severe jaw-winking phenomenon and undertook only fron talis suspension on 2 cases and one of whom had poor superior rectus function. In the cases who have undergone levator extirpation with frontalis suspension, synkinetic movement was improved in all. However, in those who underwent the frontalis suspension procedure, the synkinetic phenomenon still remained in spite of acceptable improvement of blepharoptosis in primary position.

Key Words: synkinetic ptosis;Marcus-Gunn Jaw-winking syndrome;levator extirpation with frontalis suspension