Síndrome de Marin-Amat y Marcus-Gunn invertido. Presentación de 2 casos de sincinesia facial

Abstract

Marin-Amat's syndrome is a rare associated movement, wherein contraction of orbicularis oculi is brought about by opening of the jaw in association with aberrant regeneration of facial nerve. This is the opposite of the Marcus-Gunn phenomenon; hence it has also been called Inverted Marcus-Gunn Phenomenon. Moreover in this case the opened the mouth or moved the jaw, the eye would close. This phenomenon is congenital and the closure of the eye is due to inhibition of the levator palpebrae superioris. We present two cases, one acquired after the surgery of tuberculosus cervical adenitis and other congenital with reference to the presentation, course and treatment. This entity is rare in children, with few reported cases, although probably will be found more frequently if looked for carefully. The diagnosis is clinical and does not require additional tests, although EMG may be useful to demonstrate the synkinesis.

Inverse Marcus-Gunn phenomenon

“…The inverse Marcus Gunn phenomenon is a rare congenital movement anomaly caused by cranial nerves synkinesis (2). This condition is characterized by eyelid drooping, generally the left side, during mouth opening or movements of mastication (1,3).…”

Inverse Marcus Gunn Phenomenon

“…This entity also manifests as involuntary eyelid closure on jaw opening. Despite having the same physical features as inverse Marcus Gunn phenomenon, this condition is an acquired synkinesis resulting of aberrant regeneration of the facial nerve usually after a peripheral facial palsy (2,5).…”

“…Clinical findings in the examination are sufficient for the diagnosis, so complete history and physical examination is important (2). Although it does not require additional tests for confirmation, the electromyography can be useful to identify the affected nerves.…”

“…Treatment usually is not necessary for patients with a slight degree of ptosis (2,3). In this case we opted for a conservative treatment and pediatrics consultation following.…”