The Study Of The Anatomy Of "Limited Ligament" And Orbital Septal Network And Their Relations Of The Mild Or Subclinical Ptosis

BackgroundLooking back at the facial features and history of Asians,it can be seen that in Asians,due to too thick orbital septum,the fibers from levator muscle of the upper eyelid cannot pass through the orbital septum to reach the subcutaneous area,thus the upper eyelid cannot form skin folds and presents the appearance of single eyelid.Thus,"puffy eyes" are typical of Asian eyes.After the formation of double eyelid,many plastic surgeons find that some patients have poor results after double eyelid surgery,but make the patients’ eyes more dull.In fact,the reason for this is related to the special structure between the aponeurosis of the upper palpebrae and the orbital septum,which restricts upper eyelid movement in most patients and thus presents as mild or subclinical ptosis.In previous reports,this special structure has been named as:Fibrous Bundles,Three-dimensional Web Fibrous Bands,Fibrous Web-bands,lower transverse ligament,Restricted Ligamen,etc.However,precise anatomical studies of this structure have not been carried out or published.ObjectiveIn this study,histopathological staining analysis was used to identify the anatomical sources of "the limited ligament" and orbital septal fiber network.And to explore the surgical efficacy of loosening "the limited ligament" and orbital septal fiber network in improving mild or subclinical ptosis,so as to understand the influencing factors of this operation.Methods1.Intraoperative tissues of patients with mild or subclinical ptosis were improved by the collection of "the limited ligament" and orbital septal fiber network in our hospital from January 2020 to February 2020.The specimens included ligamentum limbicum,orbital septal fiber network,orbital septum and aponeurosis of the upper eyelid levator respectively.Through the pathological analysis of tissue specimen staining,the pathological analysis results of the "limited ligament" and orbital septal fibrous network were compared with the orbital septum,aponeurosis of the upper eyelid levator,orbicularis oculi muscle and the previous research reports of the autopsy myopathy of the upper eyelid,and the conclusions were drawn.2.A retrospective analysis method was adopted to collect the relevant medical records and photos of 50 patients who underwent double eyelid surgery in our department from May 2018 to May 2019.The preoperative and postoperative effects of the patients were compared,as well as the postoperative follow-up of the patients for 6 months to 1 year,and the satisfaction with the postoperative effects of the patients was recorded.Among the collected cases,there were 7 males and 43 females.There were 3 patients with congenital unilateral ptosis.There were 45 patients with congenital mild ptosis and 5 patients with congenital subclinical ptosis.There were 4 patients aged 16-35,4 patients aged 16-20,25 patients aged 21-25,18 patients aged 26-30,and 3 patients aged 31-35.Results Through SPSS data analysis,the conclusion was drawn.Resuits1.According to the analysis of Masson and EVG staining results,it was considered that the tissue source of "the limited ligament" was orbicularis oculi muscle,and it was formed by the abnormal distribution of orbicularis oculi muscle under the orbital septum.The orbital septal fiber net is due to abnormal thickening of the orbital septum.2.Through the release limit ligaments and orbital septum of fibres to correct mild or subclinical ptosis surgery,50 cases of patients,postoperative effect is not satisfied,only 2 patients postoperative effect is not satisfied with the reason for the lack of ptosis correction,the postoperative effect in all but 2 cases accepted,and does not require secondary surgery to correct.Among them,11 were basically satisfied,accounting for 22%;37 cases(74%)were satisfactory.The total satisfaction is the sum of the basic satisfaction ratio and the satisfaction ratio,that is,the total satisfaction is 96%.The results were independent of gender,age,type of ptosis and unilateral ptosis.Conclusion1."The limited ligament" should be referred to as posterior orbicularis oculi muscle,which is the abnormal distribution of the orbicularis oculi muscle under the orbital septum and limits the movement of the levator muscle of the upper eyelid.The orbital septal fibrous network is formed due to the abnormal development of the orbital septal fascia,and the large adhesion to the aponeurosis of the upper eyelid is too tight,resulting in limited upper eyelid movement.2.Loosening posterior orbicularis oculi muscle and orbital septal fibrous network can improve mild or subclinical ptosis,with less surgical trauma,natural and sustained postoperative effects,quick postoperative recovery and fewer complications,which is a highly recommended surgical method.