Anatomy And Clinical Study Of Frontalis Aponeurosis

Objective:To observe and summarize the width and the disposition method of the implicate complex tissue for the frontalis aponeurosis and orbicularis muscle,the thickness of the implicate complex tissue for the frontalis aponeurosis and orbicularis muscle and the simple orbicularis muscle flap and the trend of the frontalis fibers.To find an improved operative procedure useing the especially anatomic structure of the implicate complex tissue for the frontalis aponeurosis and orbicularis muscle to treat severe ptosis.Method:By dissecting of 2 fresh and 2 formalin-soaked cephalosome samples,total of 8 sides specimens,marking the longitudinal as the y-axis which just pass by the pupil with the direction upward,the point for y-axis intersecting with the supraorbital margin as the origin point"o",and the horizontal line which passed by the point "o"with the direction to the temple as the x-axis:1 ) To Measure the included angle of the y-axis and frontalis fibers which just intersect with the y-axis.2) to measure the width and the anatomy localization of the the implicate complex tissue of the frontalis aponeurosis and the orbicularis muscle for the location x equal to"-1 cm.0cm.1 cm".3)To measure the thickness of the implicate complex tissue and the simple orbicularis muscle flap.4) By the SPSS 13.0,to analyze the anatomy result and give the answer for if there are differernts among the width of the implicate complex tissue on different locations and the thickness between the implicate complex tissue and the orbicularis muscle,and the 95% confidence interval for the included angle of the y-axis and the frontalis fibers.Results:By the anatomy observation on the 8 sides specimens,it was found that the frontalis aponeurosis generate from the superior border of the eyebrow,most of which intertwine with the frown muscle and the oculi-orbicularis muscle.The interlaced part was presented the appearance just like the crescente.By the spss13.0,the average 95%confidence interval for the width of the implicate complex tissue of the frontalis aponeurosis and orbicularis muscle.on the y-axis was in the range from 13.74mm to 17.55mm,on the location for x=1cm it was in the range from 11.9mm to 15.4mm,and on the location for x=-1cm it was in the range from 12.48mm to 16.05mm;the width of the implicate complex tissue on the y-axis have the differernce for it was on the location of x=1cm and x=-1cm,but there was not the difference for it on the location of x=1 cm and x=-1 cm.the 95%confidence interval of the thicker difference for the implicate complex tissue than the orbicularis oculi muscle was in the range from 0.089mm to 0.161mm,which has statistical significance;The average 95%confidence interval of the included angle of the y-axis and frontalis fibers which intersect with the y-axis was in the range from 17.5°～23.5°.Conclusion:The frontalis aponeurosis intertwine with the frown muscle,oculi-orbicularis muscle,the fabric is very tight,all of that provide anatomical basis for it as the fixation part for the treatment of severe ptosis.The implicate complex tissue of the frontalis aponeurosis and orbicularis muscle contains some of the complete orbicularis oculi muscle ring,which means that even the orbicularis oculi muscle on the super of orbital septum was resected,there was still some complete orbicularis oculi muscle ring remained and provided anatomical basis for the removal of the orbicularis oculi muscle on the super of orbital septum; The average 95%confidence interval for the included angle of the y-axis and frontalis fibers was in the range from 17.5°to 23.5°,which control the direction of the frontalis spasm during the frontalis membrane ventrofixation.The direction of the frontalis spasm was refered to the tightest point of suspl upper eyelid,which should be selected on the point where the frontalis fiber was perpendicular to upper eyelid limbus,that would make the curative effect even better; All those,to treatment of severe ptosis by the way of suspl frontal belly aponeurosis- orbital oculi muscle flap,in which the orbicularis oculi muscle on the super of orbital septum was resected and the included angle of the y-axis and frontalis fibers was refered to the tightest point of suspl upper eyelid,was one of the best options.