Marin-Amat syndrome: a case of acquired facial synkinesis.

To cite: Malhotra A. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013010030 DESCRIPTION Marin-Amat syndrome is a form of acquired facial synkinesis manifesting as involuntary eyelid closure on jaw opening. This often occurs following the aberrant regeneration of the facial nerve after a peripheral facial palsy. It is less recognised form of oculofacial synkinesis than the more well-known Marcus-Gunn-jaw-winking phenomenon (MGJWP), wherein there is eyelid elevation on the ipsilateral contraction of the lateral or medial pterygoid muscle. 2 The synkinetic movements in Marin-Amat syndrome are opposite to that seen in MGJWP. This had sometimes led to a confusion in the literature regarding another form of synkinesis called the inverse Marcus-Gunn phenomenon/syndrome. The mechanism of synkinesis are different in both, and the term inverse Marcus-Gunn syndrome should be reserved only for a congenital lesion, where the mechanism of lid closure is because of inhibition of the levator palpebrae superioris rather than orbicularis oculi contraction as seen in Marin-Amat syndrome (figure 1). 2 Most patients with minor cosmetic deformity do not need treatment, but in some cases botulinum toxin or eyelid surgery may be helpful. We describe a case of Marin-Amat syndrome in a woman who developed right-sided Bell’s palsy 9 years ago. She made a reasonable recovery but persists of have synkinesis with jaw opening causing right eyelid closure. This has caused cosmetic disfigurement and she feels awkward in social gatherings. She is self-conscious when her photographs are taken and tends to turn her head to the left to avoid presenting the right side of face.