Brown syndrome with Marcus-Gunn jaw-winking phenomenon and ptosis: distinct entities or a part of the congenital cranial dysinnervation spectrum?

INTRODUCTION

Brown syndrome involves restricted elevation in adduction due to superior oblique tendon anomalies. Marcus-Gunn jaw-winking Syndrome (MGJWS) is a congenital synkinesis between jaw movement and eyelid elevation. Their coexistence along with ptosis in the same eye is extremely rare.

METHODS

We report a case of an 8-year-old girl presenting with right eye motility restriction consistent with findings of Brown Syndrome along with MGJWS and ptosis.

RESULTS

The patient showed right hypotropia with limited elevation in adduction, consistent with Brown syndrome. Ptosis resolved with mouth opening or jaw movement, consistent with MGJWS.

DISCUSSION: This is the first pediatric report of Brown syndrome with ipsilateral MGJWS and ptosis. The combination of mechanical restriction and dysinnervation underscores the complexity of congenital cranial dysinnervation disorders and highlights the importance of thorough clinical evaluation.