Marin-Amat syndrome is a rare form of facial synkinesis resulting from aberrant connections between the trigeminal and facial nerves. This condition manifests as involuntary eyelid closure upon voluntary jaw movement. It is distinct from the more common Marcus Gunn jaw-winking syndrome (MGJWS), which involves upper eyelid elevation during mastication. Here, we reported a case of a 64-year-old woman who developed this syndrome following combat-related maxillofacial trauma to the lateral mandible, which resulted in a left facial nerve injury. After her mandibular fractures were stabilized using 2 mm plates, her medical history was notable only for hypothyroidism. Six months post-injury, and following an attempted free fibula flap procedure, the patient began experiencing involuntary facial movements. These symptoms caused significant social discomfort and difficulty with eating. Treatment options, including botulinum toxin and surgery, were discussed; however, the patient opted for a conservative management approach.

Marin Amat syndrome is a phenomenon in which eyelids close upon opening of the mouth during the recovery phase after facial nerve paralysis. In this report, we present two surgically treated cases of Marin Amat syndrome with aponeurotic ptosis. Case 1: A 66-year-old man had developed left Bell's palsy a year prior to presentation and underwent rehabilitation at the Neurology Department of Japan Community Healthcare Organization Chukyo Hospital. He was subsequently referred to the Ophthalmology Department for left eyelid ptosis. Case 2: A 75-year-old man developed left Bell's palsy more than 10 years prior to presentation and was referred to the Ophthalmology Department for left eyelid ptosis. Both patients had Marin Amat syndrome with aponeurotic ptosis. Levator aponeurosis advancement surgery and partial orbicularis oculi muscle resection were performed on the affected eyes. Both patients showed favorable postoperative outcomes. Simultaneous surgery involving levator aponeurosis advancement and partial orbicularis oculi muscle resection is effective for treating Marin Amat syndrome with aponeurotic ptosis.

Marin-Amat syndrome is a rare, irreversible, and hard-to-treat neurological sequalae that has recently been associated with COVID-19 vaccination. Given the rarity of this condition and the absence of curative treatment to date, the authors herein review the literature to date and report the first ever successful surgical treatment of 2 patients who developed Marin-Amat syndrome after ChAdOx1 nCoV-19 vaccination. In this case study, the authors treated Marin-Amat syndrome in a 45-year-old woman and a 75-year-old woman with facial palsy that developed 24 days and 4 months after receiving COVID-19 vaccination, respectively. The patients' clinical histories and physical examination results were reviewed. A literature review was performed using PUBMED for the years 1990 to the present. It is noteworthy that these are the first reported cases of Marin-Amat Syndrome to be successfully treated by surgery. The patient's neurological symptoms improved after surgical intervention in contrast with the lack of response after botulinum toxin injection and intensive rehabilitation. This study is the first to demonstrate the successful treatment of the extremely rare Marin-Amat syndrome after ChAdOx1 nCoV-19 vaccination through surgery. Selective myectomy and myotomy in situ in combination with levator plication proves to be highly effective and favorable in treating this condition as the surgery overtakes the limited effectiveness of and directly obviates the need for botulinum toxin injections, thereby improving patient satisfaction and quality of life.

While vaccination against COVID-19 is still ongoing, some rare adverse events temporally related to vaccinations have been reported, particularly with ChAdOx1 nCoV-19. Here, a 77-year-old male presented to our outpatient department with persistent ptosis of his left eye for 1 month. He initially received vaccination with ChAdOx1 nCoV-19 and developed symptoms of Bell's palsy 3 days later. He received a 14-day course of prednisolone, but the ptosis persisted. Marin-Amat syndrome was compatible with his symptoms of ptosis exacerbation during orbicularis oris exertion. A temporal correlation between ChAdOx1 nCoV-19 vaccination and Bell's palsy without infectious or autoimmune diseases was delineated. Further studies are needed to clarify the possible relationship between these two events.