Application Anatomy Study Of Orbit, Medial Canthal Ligament And Lateral Canthal Ligament

BackgroundMongoloids have a special eyelid appearance, mainly as a single eyelid, epicanthus, fat and clumsy eyelid, small palpebral fissure.This unique appearance forms Chinese traditional aesthetics. In Chinese traditional aesthetic, The curve of the eye and the ratio between eye and face are concerned by many people in China. Because epicanthus and single eyelid are prevalent in the Mongols, so they are approved by the Chinese traditional aesthetic.The Western traditional aesthetic also concerns the ratio between eye and face as the Chinese traditional aesthetic.Because of epicanthus and single eyelid are rare in the Caucasus, so that the epicanthus and the single eyelid are not approved by the traditional Western aesthetic. The different aesthetic between the Eastern and the Western are changed by the East-West cultural exchange and mutual integration of aesthetics and a new aesthetic are formed in Chinese.The wide palpebral fissure of double eyelid and smooth curve is agreed as a symbol of the beauty, while the Mongolian endemic species of upper eyelid shape is not accepted by many Chinese people.The reason of that is the endemic upper eyelid of Mongolian shape are thought as a appearance of fatigue and idleness.Mongoloids generally have fatter upper eyelid than Caucasians and more the performance of a single eyelid. This fat upper eyelid made people a sluggish performance.For changeing this fat upper eyelid, blepharoplasty has been chosen to remove the fat upper eyelid,but there are still some problem in effect of operation. We're trying to clarify the physiological mechanisms of the full upper eyelid, and provide anatomical basis for clinical.Epicanthus in the Mongoloids is up to 50%～70%.It is why many people are seeking for epicanthoplasty. As Mongoloid features, epicanthoplasty complications frequently occur. The most complications caused by the surgical incision scar and long-term results of operations difficult to maintain. So complications limited spread of epicanthoplasty.With the socio-economic development, more and more people were aware of importance of the lateral canthal angle. The appearance of the canthal angle lower than the medial canthal angle was thinked as a character of ageing by many people. In order to improve the appearance, many people were seaking for adjustment of the lateral canthal angle.As the body aged and the lateral canthal angle lowered, these might be complicated that lower eyelid ectropion, epiphora and so on. Many people had more attention in these problem. In the past, people had a only focus on correcting baggy deformity of lower eyelid, but now more and more people are concerning in adjusting the lateral canthal ligament.ObjectiveThrough gross dissection and anatomical observation on orbital area, the applied anatomy was made for take a base of anatomy for plastic and cosmetic operation on orbital area, measurement and histologic examination were taken on medial canthal ligamentwhich would explore the reason about the complication of epicanthoplasty and find the possible method to resolve it and measurement and histologic examination were taken on lateral canthal ligament which would take a base of anatomy for operation on lateral canthal ligament..Methods1.Gross dissection and microdissection were performed on the orbital area of 9 preserved cadaver and observation of applied anatomy were made for plastic and cosmetic operation.2.Gross dissection were performed on the medial canthal region and measurements of the medial canthal region were made on 9 preserved cadaver. The course of the fibers of the medial canthal ligament was observed through histological examination.3.Gross dissection were performed on the lateral canthal region and measurements of lateral canthal ligament were made on 9 preserved cadaver. The course of the fibers of the lateral canthal ligament was observed through histological examination.Results1.The anterior branch of the medial canthal ligament averaged 8.33mm±0.9mm in length.The superior branch of the medial canthal ligamnt averaged 6.41mm±1.09mm in length. The posterior branch of the medial canthal ligament averaged 8.77mm±0.81mm in length. The distance from the impetus of the medial canthal ligament to the upper orbital margin was 21.06mm±2.82mm.The distance from the impetus of the medial canthal ligament to the lower orbital margin was15.96mm±2.34mm. The distance from the impetus of the medial canthal ligament to the depressor supercilii was 7.44mm±0.75mm. The distance from the impetus of the medial canthal ligament to t supraotrochlea nerve was 21.22mm±1.75mm. The distance from the impetus of the medial canthal ligament to the angular artery and the angular vein was 9.33mm±1.15mm. The distance from the insertion of the anterior branch of the medial canthal ligament to the angular artery and the angular vein was 0.79mm±0.14mm. The distance from the insertion of the medial canthal ligament to the upper orbital margin was 20.81mm±2.61mm. The distance from the insertion of the medial canthal ligament to the lower orbital margin was17.75mm±2.12mm. The distance from the insertion of the anterior branch of the medial canthal ligament to depressor supercilii was 0.79mm±0.14mm. 2.Anterior branch of the medial canthal ligament is a dense collagen fibers, and the connections between skin and were obvious and loose fiber.3.The superficial branch of the lateral canthal ligament was 9.83mm±1.27mm in length.The deep branch of the lateral canthal ligament was 11.41mm±3.67mm in length and 4.6mm±1.2mm in width.4.The fibre of superficial lateral canthal ligament was rare and thick. The fibre of deep lateral canthal ligament was tight and slim.Conclusion1.Eyelid anatomy can be divided into three anatomical levels, skin and subcutaneous tissue layer, expression of muscle layer, orbital septum and orbital contents layer. Connection of three-level is not close to each other, and have none of significant structure, and is a good surgical plane.2.Eye cosmetic and plastic surgery should focuse on reseting of the anatomical structure3.The confusion of the orbicularis oculi and the fiber from anterior branch of the medial canthal ligament to skin is the reason of epicanthus.4.Make sure the sort of epicanthus.It should be chosen that the operation could avoid scar and make a persistent efecrt.5.By folding the front branch of the medial canthal ligament,the tension of canthal skin could be reduce in epicanthal plasty.6.Lateral canthal ligament has two branch. The deeper branch of the lateral canthus ligment was the main structure.7.The fibre of superficial branch of the lateral canthus ligment was rare and thick. The fibre of deeper branch of the lateral canthus ligment was tight and slim.8.The reason of appearance of the lateral canthus aging is the relaxation of lateral canthus ligament. The appearance of aging lower eyelid can be effecitively solved by hanging or folded deeper lateral canthus ligament.