Abstract
The lower-positioned transverse ligament (LPTL) had been thought to run parallel to the junction between the orbital septum and the levator aponeurosis (junction). However, its true course was disclosed as crossing the junction. Since earlier histological studies were undertaken before the precise course was elucidated, it was uncertain whether the true LPTL was adequately disclosed. Therefore, we examined ten upper eyelids of 6 Asian patients who underwent blepharoptosis repairs. The LPTL and the tissue running parallel to the junction were harvested intraoperatively. Light-microscopically, the LPTL contained looser and thinner collagen bundles and less elastic fibres than the parallel tissue. Electron-microscopically, collagen microfibrils in the LPTL had almost the same periodicity and thickness as those in the parallel tissue. The LPTL is a loose and inelastic structure, which at a light microscopic level is completely different from the parallel tissue; however, the differences could not be verified by electron microscopy.
Highlights
The lower-positioned transverse ligament (LPTL) is one of the main supporting structures of the upper eyelids [1,2], and usually exists in puffy upper eyelids [3]
The LPTL was believed to be positioned around the lateral horn of the levator aponeurosis, and to run in parallel with a junction between the orbital septum and the levator aponeurosis [3]
The LPTL was shown to originate from the trochlea, run inferolaterally and to pass the junction, where it reflected the posterior aspect of the orbital septum, and to reach the lateral orbital rim (Fig. 1)
Summary
The lower-positioned transverse ligament (LPTL) is one of the main supporting structures of the upper eyelids [1,2], and usually exists in puffy upper eyelids [3]. The LPTL was believed to be positioned around the lateral horn of the levator aponeurosis, and to run in parallel with a junction between the orbital septum and the levator aponeurosis (junction) [3]. The true LPTL differs from the tissue running parallel to the junction. We histologically examined the LPTL and the tissue running parallel to the junction using light and transmission electron microscopy. Tissue sections of the formalin-fixed specimen were stained with Elastica van Gieson [6], which were used in a former study [3], and examined light-microscopically (BX-40, OLYMPUS, Tokyo, Japan). Ultra-slice sections fixed in glutaraldehyde were stained with lead and uranyl acetate and were examined with a transmission electron microscope (JEM-1200EX, JEOL, Tokyo, Japan)
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