Marcus Gunn phenomenon
Overview
Marcus Gunn phenomenon (a.k.a. Marcus Gunn Jaw-Winking or Trigemino-oculomotor Synkineses) is an autosomal-dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis: when two or more muscles that are independently innervated have either simultaneous or coordinated movements.
Symptoms
* Drooping eyelid * Brief eyelid lifting when mouth opened
Causes
Dental or periodontal pathology –Associated with temperature sensitivity and pain upon biting * TMJ disorders –Associated with unilateral or bilateral achy pain and diffuse tenderness of the masseter and temporalis muscles –Exaggerated by jaw use –Joint may be tender to palpation –“Clicking” sounds are often present –More common in females age
Diagnosis
1. Are there abnormalities on examination of the teeth or gums? A thorough examination of the teeth and gums may disclose dental caries , gingivitis, oral tumors, or alveolar abscess. 2. Is the pain intermittent? Intermittent pain should suggest a trigeminal neuralgia or glossopharyngeal neuralgia. 3. Is there a rash? The presence of a rash would suggest herpes zoster. Be sure to examine the eardrum for Ramsay Hunt's syndrome.
Prognosis
The 'prognosis' of Marcus-Gunn phenomenon usually refers to the likely outcome of Marcus-Gunn phenomenon. The prognosis of Marcus-Gunn phenomenon may include the duration of Marcus-Gunn phenomenon, chances of complications of Marcus-Gunn phenomenon, probable outcomes, prospects for recovery, recovery period for Marcus-Gunn phenomenon, survival rates, death rates, and other outcome possibilities in the overall prognosis of Marcus-Gunn phenomenon. Naturally, such forecast issues are by their nature unpredictable.
Treatment
* Dental or periodontal pathology, oral lesions, salivary pathology, and oral neoplasms require specialized treatment by dental specialist or oral surgeon * TMJ: Initial treatment includes pain management, bite block (night guard), cold/warm compresses, intra-articular steroid/lidocaine injections, and avoidance of jaw clenching and gum chewing * Temporal arteritis: Temporal artery biopsy and high- dose steroids * Headache: Pain relievers, stress reduction, migraine-specific therapy (e.g., triptans), and manipulation * Neuralgia and neuropathies may be treated with NSAIDs, anticonvulsants (e.g., valproic acid, gabapentin), medical pain management and/or directed therapy (e.g., nerve block) * Treat underlying systemic etiologies and behavioral disease as necessary