Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus
Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus
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DOI：
10.1097/00006534-200209010-00025
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发表时间：
2002-09-01
影响因子：
3.6
通讯作者：
Adams, WP
中科院分区：
文献类型：
--
作者：
Muzaffar, AR;Mendelson, BC;Adams, WP
面部浅筋膜的外科解剖描述必须包括其深层附着。这些附着物被绘制成前额、太阳穴和脸颊的固定韧带。下眼睑和外眦的眼轮匝肌的深层附着在眼睑固定术中早已被认识到，但尚未被正确定义。6具新鲜尸体在组织学支持下进行了解剖，结果与手术观察相关联。眼轮匝肌深部筋膜通过眼轮匝肌保持韧带附着于眶缘骨膜。这种附着在中央最弱，在下外侧眶缘最紧。保持韧带与外眦外的扩张纤维附着融合，外眦外眶增厚，其延伸到邻近的颞深筋膜上的外侧眶缘。年龄变化与眶壁增厚和眼轮匝肌保持韧带提供的韧带支撑减弱有关，这使得眼睑下缘向下移位，并导致该区域的典型年龄效应。眶外侧区的浅筋膜具有连续的结缔组织结构，通过睑板连接将颞顶筋膜和眼轮匝肌筋膜连接到外眦肌腱。在某些眼眶固定术和年轻化手术中，释放眼轮匝肌筋膜的深韧带附件（外侧眼眶增厚和眼轮匝肌保留韧带）是很重要的。这种松解术可以有效地重新遮盖下眼睑的眼轮匝肌和颧前软组织并使其向上活动。
Description of the surgical anatomy of the superficial fascia of the face must include its deep attachments. These attachments have been mapped out for the forehead, temple, and cheek as retaining ligaments. The deep attachments of the orbicularis oculi of the lower lid and lateral canthus have long been recognized in canthopexy surgery but have yet to be properly defined. Six fresh cadavers were dissected with histologic support, and the results were correlated with surgical observations. The fascia of the deep aspect of the orbicularis is attached to the periosteum of the orbital rim by an orbicularis retaining ligament. This attachment is weakest centrally and tightest over the inferolateral orbital rim. The retaining ligament fuses with an expanded fibrous attachment beyond the lateral canthus, the lateral orbital thickening, which extends over the lateral orbital rim onto the adjacent deep temporal fascia. Aging changes are associated with attenuation of the ligamentous support provided by the orbital thickening and the orbicularis retaining ligament, which then allows inferior displacement of the lower boundary of the lid and contributes to the typical effects of age in this region. The superficial fascia of the lateral orbital region has a continuous connective tissue structure linking the temporoparietal fascia and orbicularis fascia to the lateral canthal tendon by means of the tarsal plate connection. Release of the deep ligamentous attachments (lateral orbital thickening and orbicularis retaining ligament) of the orbicularis fascia is important in some canthopexy and in rejuvenation procedures. The release allows effective redraping and upward mobilization of the orbicularis of the lower lid and the premalar soft tissues.