手术治疗Marcus-Gunn综合征(附一例报告)

Marcus-Gunn综合征是一种罕见的眼病,又称下颌瞬目综合征。患眼的提上睑肌与咀嚼肌发生异常联合运动。因发病机理不明,故仅能对症治疗。对于轻症者多主张不予处理,重症者可手术治疗。笔者所见国内先后7例报告症状均较轻,无一例手术治疗。报告一例17岁女性患者,右上睑严重下垂,平视时上睑完全遮盖角膜,极似完全性上睑提肌麻痹。张口时下垂的上睑明显抬起,睑缘位置较健侧为高。咀嚼时,下垂的上睑随下颌运动上下启阖。严重影响容貌。患者迫切要求手术治疗,经施行右上睑异体巩膜额肌悬吊术及上直肌缩短、下直肌后退术后,效果较好,容貌明显改观,认为额肌悬吊术是治疗本综合征的安全、有效的方法。

Surgical Treatment of Marcus-Cunn Syndrome: A Case Report

Marcus-Gunn syndrome, also called jaw-winking syndrome, is a rare disease characterized by combined movements of musculus levator palpabrae and masseter muscles, whose etiology is far from clear and treatment used to be symptomatic. It is postulated to give no treatment to the mild cases and operations to those severe. The seven cases reported in domestic literature were all mild and treated without operation.The case reported here was a girl of seventeen, came for operation with severe ptosis of her right upper eyelid, covering up totally the right cornea while looking straight forward, similar to complete paralysis of musculus levator palpabrae. While opening her mouth the patient could have her right eyelid raised with the palpabral margin even slightly higher than that of the left. The right upper eyelid went up and down during the movements of mandibles. Sling operation was performed successfully with hetero-scleral grafting between her right upper eyelid and musculus frontalis, together with operations of further shortening of musculus religiosus and drawing back of musculus rectus oculi inferior. The patient changed to a good look. It is believed by the authors that the sling operation of musculus frontalis is a safe and effective method in surgical treatment of this syndrome.