A 3-year-old boy has left upper eyelid ptosis present since birth. The left lid elevates noticeably whenever he opens his mouth or moves his jaw to the right. Levator action is 3 mm. There is no amblyopia. What is the most appropriate surgical procedure?

• A Frontalis suspension ✓
• B Fasanella-Servat procedure
• C Levator aponeurosis advancement
• D Muller muscle-conjunctival resection

Explanation

This is congenital ptosis with Marcus Gunn jaw-winking synkinesis, an aberrant connection between the motor branch of the trigeminal nerve to the pterygoid muscle and the levator palpebrae superioris. With levator action of only 3 mm (poor levator function, under 4 mm), frontalis suspension is the operation of choice because the levator cannot be effectively advanced. Aponeurosis advancement and Muller resection require good levator function, and Fasanella-Servat is reserved for minimal ptosis, so all three fail on the levator function criterion alone.

Reference: Khurana AK, Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.