Intermuscular Transverse Ligament Goes under the Orbital Part of the Lacrimal Gland and Attaches to the Lateral Orbital Wall

Abstract

The intermuscular transverse ligament (ITL) originates from the connective tissue around the trochlea with Whitnall ligament, and separates from Whitnall ligament at the medial side of the levator palpebrae superioris muscle (LPS). It goes under the orbital side of the LPS and rejoins Whitnall ligament lateral to the LPS. After attaching to the orbital part of the lacrimal gland, it finally attaches to the lateral orbital wall. 1 - 3 A detailed report of the ITL was first published in 1995,' although there had been some brief descriptions of it before. 4 , 5 Almost concurrently with this first report, other articles were published. 2 , 3 The ITL was recognized at the time as an independent anatomical structure, covering the LPS like a sleeve in cooperation with Whitnall ligament, and thought to act as a fulcrum. 1 , 2 However, while the macroscopic medial attachment of this ligament was clearly presented, 1 - 3 its appearance around the lateral orbital wall was only microscopically, not macroscopically, 1 detailed. We have macroscopically observed the precise course of the ITL from the lacrimal gland to the lateral orbital wall and present clear photographs.