Anatomic study of the lateral palpebral raphe and lateral palpebral ligament.
ABSTRACT The aim of this study is to elucidate anatomic detail of the lateral canthal area relating to lateral canthoplasty. Thirty-three hemifaces of 22 Korean adult fresh cadavers were used. Thirty-one specimens were used for tension measurement and 2 for histologic study. There were 3 components of the lateral canthal area under the skin; lateral palpebral raphe (LPR), superficial lateral palpebral ligament (SLPL), and deep lateral palpebral ligament (DLPL). Lateral ends of superior and inferior orbicularis oculi muscles interlaced at the lateral commissure and formed LPR. SLPL extended from the lateral ends of tarsal plate to the periosteum of lateral orbital rim. Its transverse length was 9.4 +/- 2.6 mm and vertical width was 3.6 +/- 1.3 mm. DLPL extended from the lateral ends of tarsal plate deep to the origin of SLPL to Whitnall's tubercle on zygomatic bone inside the orbital margin. It is located deeper than SLPL. Its transverse length was 7.3 +/- 1.6 mm and its vertical width was 9.0 +/- 1.6 mm. Tensile strength of DLPL was 73.2 +/- 26.8 N and stronger significantly than SLPL (30.0 +/- 17.3 N). Tensile strength of LPR was 12.2 +/- 8.0 N and weaker significantly than SLPL and DLPL. A detailed understanding of 3 layered structures (LPR, SLPL, and DLPL) at lateral canthal area is conducive to performing lateral canthoplasty.
- [show abstract] [hide abstract]
ABSTRACT: The youthful palpebral fissure can be described as long and narrow. Both the aging process and transcutaneous lower blepharoplasty can cause descent of the lower lid margin and medial migration of the lateral canthus, resulting in a rounding of the palpebral fissure. This article presents a technique to correct significant postsurgical lower lid malposition and palpebral fissure distortion without the use of outer or inner lamellar grafts. In overview, subperiosteal dissection frees scarred lid structures and cheek soft tissues, creating a continuous composite flap. Elevation of the cheek soft tissues recruits deficient outer lamellae and allows the sub-orbicularis oculi fat to be positioned between the orbital rim and scarred lid structures, filling this space and helping to support the repositioned lid margin. Titanium screws placed in the lateral orbit provide a point for secure fixation of elevated cheek tissues. Transosseous wire fixation securely repositions the lateral canthus. This procedure not only restores lower lid position and the vertical height of the palpebral fissure, but it also restores the palpebral fissure's horizontal length and the lateral canthal angle. It has been effective in correcting palpebral fissure distortion after lower blepharoplasty in 15 patients during a 6-year period.Plastic & Reconstructive Surgery 02/2003; 111(1):441-50; discussion 451-2. · 3.54 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Most patients who undergo facial cosmetic surgery procedures that could cause lower eyelid retraction or ectropion should have an additional surgical procedure to support the lower eyelid and lateral canthus. The lower eyelid should be supported when performing laser planing of the eyelid; midface elevation through a lower eyelid incision approach; or conventional blepharoplasty, in patients with lower eyelid laxity. Suspending the lateral canthus by surgically altering the lateral canthal tendon is a proven technique that can provide support for the lower eyelid. However, a technique of this complexity may be unnecessary for most cosmetic surgery patients. To increase understanding of the fascial support system of the lateral canthus, four fresh cadaver dissections were performed to investigate the attachments of the lateral canthus to the lateral orbital rim. The most commonly appreciated attachment between the eyelids and the lateral orbital rim is the lateral canthal tendon (the lateral canthal raphe). However, the lateral canthus also is attached to the orbital rim at a more superficial level through the septum orbitale. This superficial fascial plane may be modified and used as a structure to stabilize or suspend the lateral canthus. This structure is defined in this article as the "superficial lateral canthal tendon."Plastic & Reconstructive Surgery 04/2002; 109(3):1149-57; discussion 1158-63. · 3.54 Impact Factor
- Journal of anatomy and physiology. 08/1911; 45(Pt 4):426-32.