A 60-year-old man presents with congenital-appearing ptosis since childhood, reduced levator function (4 mm), and absence of the upper lid crease. Jaw-winking phenomenon is elicited. Which surgical procedure is most appropriate?
- A Frontalis brow suspension using fascia lata ✓
- B Fasanella-Servat procedure (tarsomullerectomy)
- C External levator resection
- D Müllerectomy alone
Correct answer: A. Frontalis brow suspension using fascia lata
Explanation
Marcus Gunn jaw-winking ptosis with poor levator function (≤4 mm) is best managed by bilateral frontalis brow suspension. The levator muscle in these patients is anomalously innervated by the trigeminal nerve (aberrant branch to lateral pterygoid), so resecting it would not correct ptosis and could worsen jaw-winking. Frontalis suspension bypasses the levator mechanism entirely. Fasanella-Servat is for mild ptosis (1–2 mm) with good levator function; external levator resection requires >4 mm levator function.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.