Superior Palpebral Research Articles

A case series: 3-dimensional computed tomographic study of the superior orbital vessels: Superior orbital arcades and their relationships with the supratrochlear artery and supraorbital artery

Vascularcomplications from periorbital intravascular filler injection are major safety concerns. To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections. Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm. Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries. The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection. This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.

A prospective study on the role of removal of pretarsal tissue in Asian blepharoplasty

Background: Surgical creation of a superior palpebral fold, known as the double-eyelid operation (Blepharoplasty), has become the most popular cosmetic surgery in Asia. One of the distinguishing features between an individual of Asian descent and western descent is the absence or presence of an upper eyelid crease. An eye with a double-eyelid looks fresh, youthful, and attractive. Several techniques to create a unique esthetic kind of double eyelid in the Asian population has been reported. Aims: Keeping up with the recent evolving techniques, our study is designed to study the role of removal of pretarsal tissue in Asian Blepharoplasty and to analyze the esthetic outcome. Materials and Methods: Study Variables used were age, sex, address, maximum crease height, height of eyebrow, intercanthal distance, and interpupillary distance. Outcome Measures were symmetry of both the eyelid crease and subjective aesthetic appearance. Settings and Design: An interventional prospective study was a tertiary hospital setup in Manipur, India, or a period of 2 years. Double-eyelid operation (Blepharoplasty) was performed on a total of 91 cases, with removal of pretarsal tissues along with a strip of pretarsal orbicularis oculi. Statistical Analysis: The data analyzed with IBM SPSS Statistics 21 developer. Descriptive statistics mean were used for statistical analysis and paired t-test for quantitative data. Results: A total of 91 operated cases were analyzed, taking variables - age, sex, address, maximum crease height, height of eyebrow, intercanthal distance, and interpupillary distance. Outcome measures were symmetry of both the eyelid crease and subjective esthetic appearance. It was found out that majority of the crease height remain unchanged from the intraoperative marking level. Making the preoperative planning a reliable representation of final outcome, and 76 cases (83.5%) were in Grade I subjective esthetic outcome and only 1 case was in Grade III (unsatisfied). Conclusion: Remove the pretarsal connective tissue and part of orbicularis muscle allowed for better fixation, smooth skin surface and leaving less tissue to become postoperatively edematous. Along with minimal fat excision helps to avoid a sunken sulcus. This technique gives good esthetic outcome. The procedure makes the newly created double-eyelid appear natural and more beautiful after complete recovery.

Topographic Anatomy of the Inferior Medial Palpebral Artery and Its Relevance to the Pretarsal Roll Augmentation.

A detailed analysis of the topography of the inferior medial palpebral artery is needed to optimize the safety and efficacy of pretarsal roll augmentation. Thirty-one hemifaces from 13 Korean and 8 Thai cadavers (15 male and six female cadavers) were dissected. The distributions of the inferior medial palpebral artery were determined with respect to the superior medial palpebral artery and the supratrochlear artery. Four distribution patterns were observed. The inferior and superior medial palpebral arteries branched individually from the ophthalmic artery, with the ophthalmic artery terminating as the supratrochlear artery on the forehead (type I); a short trunk branched from the ophthalmic artery and divided into the inferior medial palpebral artery and superior medial palpebral artery, and the ophthalmic artery terminated as the supratrochlear artery (type II); the inferior and superior medial palpebral arteries arose together from the ophthalmic artery, and the ophthalmic artery terminated as the supratrochlear artery (type III); or the inferior and superior medial palpebral arteries were the terminal branches of the ophthalmic artery, with the supratrochlear artery arising from the angular artery (type IV). The diameter of the artery was 0.94 ± 0.22 mm at the entry point and 0.37 ± 0.11 mm at the lateral canthus. The inferior medial palpebral artery was located along the tarsal plate deep to the pretarsal part of the orbicularis oculi in the lower eyelid. Injections to augment the pretarsal roll should be made between the subcutaneous tissue and this pretarsal part of the orbicularis oculi.

Levator palpebrae superioris and its correlation with superior palpebral crease

Levator palpebrae superioris and its correlation with superior palpebral crease

Vaskularisasi Pembuluh Darah Arteri Mata (Organum visus) pada Kambing Lokal (Capra sp.)

Eye (organum visus) vascular of local goat (capra sp.)ABSTRACT. The aim of the study was to determine of eye vascular in local goat (Capra sp.) The study used a local goat, aged 2 years old. Observation was made after specimen preparation. The observations was documented using a digital camera and analyzed descriptively. The vascular to the eye originated from externa ophthalmica artery and divides into several branched musculares arteries, lacrimalis artery, rete mirabile ophthalmicum gives off supraorbitalis artery, ethmoidalis artery, anteriores ciliares arteries and anastomoses with interna ophthalmica artery and devides into lateralis posterior longae ciliares arteries and medialis posterior longae ciliares arteries and the terminal branched into lateralis posterior shortae ciliares arteries and medialis posterior shortae ciliares arteries. Superficial temporalis artery gives off two branches lateralis inferior palpebral artery and lateralis superior palpebral artery. Malaris artery gives off two branched medial inferior palpebral artery and medial superior palpebral artery.

Size of the Superior Palpebral Involuntary Muscle (Müller Muscle)

The aim of this study was to elucidate the width and length of the superior palpebral muscle by using anti-α-smooth muscle actin antibody. Ten orbits of 5 adult Korean cadavers were used. Eyelids were cut in vertical planes through midpupilliary, medial limbus, and lateral limbus and in horizontal planes at the anterior border of the superior transverse ligament and 2 mm proximal to the upper tarsal border. Superior palpebral muscle was localized using mouse monoclonal anti-α-smooth muscle actin and counterstained with light green for collagen. In enlarged pictures of sections, widths, lengths, and thicknesses of the superior palpebral involuntary muscle were measured with a curved scale and were analyzed. The levator palpebrae superioris muscle was divided into superficial and deep parts below the superior transverse ligament. The levator aponeurosis originated from the superficial part and the superior palpebral muscle originated from the deep part of the levator palpebrae superioris muscle. The aponeurosis was inserted into the upper border of tarsus. The superior palpebral muscle fibers arose 2.71 ± 0.64 mm posterior to the anterior border of the superior transverse ligament. The superior palpebral muscle was trapezoidal. The lengths of its sides were 15.58 ± 1.82 and 22.30 ± 5.25 mm, and its height was 13.70 ± 2.74 mm. The levator aponeurosis covered the superior palpebral muscle anteriorly. The width of the levator aponeurosis was approximately 4 mm wider than the superior palpebral muscle. The thicknesses of the superior palpebral muscle were 0.14 ± 0.13 mm at the anterior border of the superior transverse ligament, 0.45 ± 0.11 mm at the superior fornix level, and 0.10 ± 0.03 mm at the upper border of the tarsal plate. One vascular layer was between the levator aponeurosis and the superior palpebral muscle (upper vascular layer), and the other was between the superior palpebral muscle and the conjunctiva (lower vascular layer). At the superior fornix level, thickness of the upper and lower vascular layers was 0.28 ± 0.06 and 0.38 ± 0.21 mm, respectively. The result of our study might contribute to corrective blepharoptosis surgery.

A Simple, Minimally Invasive Method for Creation of the Superior Palpebral Fold in Asians With the Modified Continuous Buried Tarsal Stitch

A simple, minimally invasive stitch method to construct the superior palpebral fold in Asian upper eyelids is described. With the use of a clear 6-0 monofilament polypropylene suture and a continuous stitch and by securing multiple consecutive transcutaneous intratarsal fixations, we were able to produce a consistent, natural result with high success rates and no noticeable scarring in 1648 cases over a 9-year period at 2 surgical centers in Toronto, Ontario, Canada, and Chengdu, China.

The vascular system of the upper eyelid. Anatomical study and clinical interest

Thorough knowledge of the vascular supply is indispensable for repair and oncologic surgery of the eyelids, and has a significant impact on the management of complex defects of this region. This anatomic study was performed with five fresh cadavers after arterial injection of coloured neoprene latex. The distribution of the vascular system of the upper eyelid was examined after dissection and photographic study. It is made up of three arcades: the preseptal arcade, the supratarsal arcade, and the marginal arcade, under the orbicularis oculi muscle. These arcades are supplied by branches of the ophthalmic artery (supraorbital artery, supratrochlear artery and medial palpebral artery) and branches of the facial artery and temporal artery. Small vertical branches arising out of these arcades provide an anastomotic network. This anatomical study aimed to describe the vascular system of the upper eyelid in order to search for constant features and to map the blood supply of the principal upper lid flaps.

Repair of inner canthus surgical wound using superior palpebral artery based advancement flap

Small defects of the inner canthus can be difficult to repair with an aesthetically satisfactory result, due to the difficulty in matching skin types and the resulting donor site scars. We describe a technique which we have employed for repairing skin defects around the inner canthus, using a cutaneous advancement flap from the upper eyelid, based on the superior palpebral artery. Complete excision of the lesion was possible, and a cosmetically acceptable result was obtained. By using this technique, skin is moved within one aesthetic unit, thus maximising skin type matching and cosmetic results. In addition, the technique creates a donor site which can be easily hidden within the natural creases of the upper lid, and the arterial supply maximises the chances of flap survival.

The arterial anatomy of the eyelid: importance for reconstructive and aesthetic surgery

The aim of the study was to investigate the arterial distribution of the eyelids. The location, course, length and diameter of eyelid arteries were determined in 19 preserved and latex injected adult male cadaver heads. The diameter of the medial palpebral artery was found to be 1.50+/-0.28mm on the right, and 0.70+/-0.12mm on the left. The diameter of the lateral palpebral artery was measured as 0.62+/-0.10mm on the right, and 0.59+/-0.12mm on the left. The medial palpebral arteries travelling in the medial part of the eyelids usually arose as separate branches for the upper and lower lids, as superior and inferior medial palpebrals. In all cases, four arterial arcades, the marginal, peripheral, superficial orbital, and the deep orbital arcades, were revealed in the upper palpebra. These arterial arcades gave off small perforating branches. The perforating branches were identified on both sides of the tarsal plate and the orbicularis muscle. In four cases (11%) visible arterial variation was found near the inferolateral end of the levator palpebrae. Although many differences in the arterial features of the eyelid have been noted, there may not be a significant difference in the basic vasculature of the palpebra among races. A better understanding of the palpebral vascularity should allow modification of reconstructive techniques and reduce postoperative complications after eyelid surgery.

Objective Changes in Brow Position, Superior Palpebral Crease, Peak Angle of the Eyebrow, and Jowl Surface Area After Volumetric Radiofrequency Treatments to Half of the Face

Objective Changes in Brow Position, Superior Palpebral Crease, Peak Angle of the Eyebrow, and Jowl Surface Area After Volumetric Radiofrequency Treatments to Half of the Face

Objective Changes in Brow Position, Superior Palpebral Crease, Peak Angle of the Eyebrow, and Jowl Surface Area after Volumetric Radiofrequency Treatments to Half of the Face

Objective Changes in Brow Position, Superior Palpebral Crease, Peak Angle of the Eyebrow, and Jowl Surface Area after Volumetric Radiofrequency Treatments to Half of the Face

The lacrimal fascia redefined.

It has been commonly accepted that the lacrimal fascia is an intact septum, composed of connective tissue, that separates the orbital cavity into a large compartment, which contains the eyeball, and a small compartment, which contains the lacrimal sac and nasolacrimal duct. the septum, however, is not necessarily always intact. We found a circular or oval opening in the lacrimal fascia in 37 of 52 specimens (71.2%) examined. The opening, which we shall refer to as the lacrimal fascial foramen, was located at variable levels in the lacrimal fossa. The lacrimal fascial foramen was buried in fatty tissue through which passed a branch of either the inferior palpebral artery or the infraorbital artery and a vein of the nasolacrimal duct. The clinical implications of the lacrimal fascial foramen in obstruction of the nasolacrimal duct are discussed.

On the A. Malaris of the Goat (Capra hircus)

Detailed observations were made of the a. malaris in 25 adult goats by means of the acryl plastic injection method and the findings obtained were evaluated in comparison with those for other mammals. The malar artery arose from the superior wall of the infraorbital artery, lateral to the infraorbital nerve and superomedial to the maxillary tuber, independently or rarely in common with the superior alveolar artery. It first passed anterolaterally in the sulcus malaris on the superior surface of the lacrimal bulla and gave rise to the third palpebral branch independently or rarely in common with the inferior oblique muscular branch beneath the obliquus inferior muscle, and also the main and accessory inferior oblique and the maxillary sinus branches. The third palpebral branch gave off the periosteal, the conjunctive, the supero- and inferolateral branches. After the malar artery gave off the zygomatic branch on the orbital surface of the zygomatic bone, it passed anterosuperiorly up to the incisura malaris at the medial end of the infraorbital margin of the lacrimal bone and gave off the medial superior and inferior palpebral arteries or a common trunk between them. It continued to pass forwards as the nasal radical branch after giving off the infraorbital marginal branch and anastomosed with the nasal dorsal branch of the superficial temporal artery. The medial inferior palpebral artery formed the inferior palpebral arterial arch by anastomosing with the lateral inferior palpebral artery of the superficial temporal at the lateral canthus. The inferior palpebral marginal, the ocular orbicular muscular and the conjunctive branches diverged from the above arterial arch. The medial superior palpebral artery gave off the lacrimal canalicular and the nasolacrimal canal branches and anastomosed with the lateral superior palpebral artery or the frontal branch of the superficial temporal at the medial canthus. The characteristic features of the malar artery in the goat were thus the third palpebral branch occasionally diverging from the external ophthalmic artery of the maxillary artery, a main and several accessory inferior oblique muscular, the maxillary sinus branches and the zygomatic branches.

On the A. malaris of the Common Squirrel Monkey (Saimiri sciureus)

Detailed observations were made of the a. malaris in 11 adult common squirrel monkeys (Saimiri sciureus) utilizing the plastic injection method. The malar artery was well-developed in all 21 examples observed and arose medially from the infraorbital artery proximal to the entrance of the infraorbital canal and lateral to the obliquus inferior muscle. The a. malaris passed superomedially outside the periorbita on the orbital surface of the maxilla and curved medially in front of the muscle, where it gave rise to the infraorbital nerve, the periosteal, the inferior oblique muscular and the infraorbital marginal branches. However, these branches arose directly from the infraorbital artery in many cases. The malar artery ascended in the lower eyelid up to the bottom of the lacrimal sac, where it gave rise to the third palpebral branch and the medial inferior palpebral artery. This artery did not anastomose with peripheral branches of the supraorbital artery. The malar artery continued to pass superomedially behind the lacrimal sac and gave off the nasolacrimal canal and the lacrimal sac branches. However, the former arose in common with the latter in many cases. The malar artery finally ascended behind the medial palpebral ligament after giving off the dorsal nasal branch and the medial superior palpebral artery at the superior end of the lacrimal sac. Its main stream formed a strong communication with the dorsal nasal artery of the supraorbital artery. This communication in an arc was characteristic in the common squirrel monkey. The medial inferior and superior palpebral arteries were well-developed in all examples and formed distinct, inferior and superior palpebral arterial arches by anastomosing with the lateral fellows of the lacrimal, respectively. A large arterial ring surrounding the upper tarsus was constructed from the superior palpebral arterial arch, branches of the lateral superior palpebral artery and the palpebral branch of the supraorbital artery.

ネコのＡ． ｍａｌａｒｉｓについて

The a. malaris of the cat was studied by utilizing the acryl plastic injection method. This artery generally arose from the infraorbital artery in common with the anterior nasal dorsal artery, or rarely in common with the anterior superior alveolar artery. It gave rise to the inferior oblique and the third palpebral branches at the superoanterior end of the origin of the obliquus inferioris muscle. The former always was a stout vessel as it was also in some mammals. The latter was especially developed in the cat and divided into the third palpebral glandular branch and others to supply the whole third palpebra. The a. malaris gave rise to the periosteal and the nasolacrimal branches on the orbital surfaces of the lacrimal and frontal bones. It finally terminated in the medial superior and inferior palpebral arteries. They, however, did not form superior and inferior arterial archs in the respective palpebra as observed in the rabbit. The medial inferior palpebral artery gave rise to the nasolacrimal, the lacrimal sac, the nasal radical, the ocular orbicular, the infraorbital marginal, the conjunctival and the cutaneous branches. The medial superior palpebral artery gave rise to thesuperior palpebral levator and the supraorbital marginal, after giving off the lacrimal sac and the nasal radical branches. The cutaneous branch anastomosed with the branches of the superficial temporal artery.The anterior nasal dorsal artery arising in common with the a. malaris in most cases formed a fine network with many fine branches of the a. malaris, which spread on the face, especially in an area centeral to the medial canthus.

The orbital vessels of rhesus monkeys

The orbital vessels in rhesus monkeys were studied. The arterial supply is by the ophthalmic artery, a branch of the internal carotid artery in the cranial cavity. The ophthalmic artery gives multiple branches throughout its entire course: from the intracranial part, a prominent ophthalmic communicating artery; from the intracanalicular part, one or more branches; from the intraorbital part, the central retinal artery, lateral posterior ciliary artery, lacrimal artery, branch to superior rectus, medial muscular artery in common with medial posterior ciliary arteries, branch to medial rectus, ethmoidal artery, branch to levator palpebrae superioris, medial palpebral artery, diploic branch, and terminal branches (supraorbital, supratrochlear and, rarely, dorsal nasal), generally in that order from the proximal to the distal part of the artery. Their origin, course and supply are discussed. The arterial pattern of rhesus monkeys is compared with that of human beings. The venous drainage is by superior and inferior ophthalmic veins which join together near the superior orbital fissure to open ultimately in the cavernous sinus. Tributaries of each vein are described with particular reference to the ocular veins.

Superior palpebral furrow construction

Superior palpebral furrow construction

Absence of Superior Palpebral Fold in Slit Eyes : An Anatomic and Physiologic Explanation

Absence of Superior Palpebral Fold in Slit Eyes : An Anatomic and Physiologic Explanation

Simultaneous Construction of the Superior Palpebral Fold in Ptosis Operation

Simultaneous Construction of the Superior Palpebral Fold in Ptosis Operation