Bilateral Marcus Gunn jaw-winking syndrome

A 10-year-old boy presented with alternating elevation of his eyelids upon chewing, present since birth (video on the Neurology(R) Web site at Neurology.org). Examination showed mild left ptosis but no ophthalmoparesis. This represents Marcus Gunn jaw-winking syndrome (MGJWS), also called trigemino-oculomotor synkinesis or pterygoidlevator synkinesis. It likely results from aberrant connections in the midbrain between trigeminal mesencephalic nucleus and oculomotor nucleus, although others have postulated connections between the mandibular division of trigeminal nerve innervating lateral pterygoid and the superior division of oculomotor nerve innervating levator palpebrae superioris. MGJWS occurs in 2%-13% of patients with congenital ptosis.1 It is usually unilateral but rarely presents bilaterally.2