内眦韧带的应用解剖及组织学研究

目的　研究内眦韧带的分支、走行、附着及其组织学构成。方法　对 6例 12侧尸颅内眦韧带进行解剖观察及测量 ,对 8例 8侧尸颅内眦结构进行组织学切片 ,光镜下观察内眦韧带的纤维构成及内眦区精细构造之间的关系。结果　内眦韧带前支的长度为 7.6± 1.5mm ,最大宽为 4 .5± 0 .7mm ,最小宽为 2 .3± 0 .5mm ;后支长度为 8.0± 1.0mm ,宽度为 6 .4± 1.4mm ;上支长度为 6 .7± 1.5mm ,宽度为 4 .5± 1.1mm ;前支距鼻颌缝的距离为 2 .8±1.0mm ,距鼻额缝的距离为 7.8± 1.5mm ;双侧韧带附着处之间的距离为 13.1± 2 .3mm。结论　内眦韧带由三个分支构成 ,均附着于骨膜。它们主要成分为胶原纤维 ,弹性纤维含量较少。眼轮匝肌内眦区的深层纤维通过组织移行参与构成内眦韧带。     

A simple method for medial canthal reconstruction

A simple method for medical canthal wiring reconstruction with the help of a homolaterally fixed osteosynthesis plate and a metal wire is presented. This avoids transnasal wiring and gives superior control when correcting the position of the lacerated Omedial canthus.     

A new technique for medial canthal tendon fixation

Traumas resulting from naso-orbitoethmoidal fractures and tumor surgery of the medial canthal region may cause orbital dystopia. A variety of techniques with many disadvantages, such as detachment and high cost, has been described for reattachment of medial canthal tendon. We present a new technique, namely, unitransnasal canthoplasty, which is easy to apply, cheap, and reliable. Two nonabsorbable sutures were passed through 2 drill holes to the nasal cavity, taken out from the nasal ostium, and were tied up. Upper and lower eyelids were fixed to the ipsilateral nasal bone.     

Appraisal of a modified medial canthal plication for treating laxity of the medial lower eyelid.

PURPOSE: The purpose of this study was to evaluate the efficacy of modified medial canthal tendon plication technique for correcting laxity of the medial end of the lower eyelid. MATERIAL AND METHODS: Eleven patients (9 males and 2 females, 21 eyes), with an age range of 31-80 years, having laxity of the medial end of the lower lid of varying degrees were enrolled in this study. These patients presented with complaints of watering, recurrent redness, photophobia and foreign body sensation. After grading the amount of lower lid laxity, plication was performed. In patients in whom laxity was associated with ectropion, the severity of lower lid ectropion was also graded. In patients with ectropion of Grade II or more, additional procedures for its correction were performed before undertaking plication. The patients were followed up 6 months post-operatively and re-assessed for laxity, recurrence of symptoms and complications of plication. RESULTS: All the lids were evaluated for the amount and extent of laxity of lower lid. Twelve (57%) eyes had Grade I, 9 (43%) had Grade II (and none Grade III) laxity of the lower lid. Twelve eyes had laxity restricted to the medial end and 9 eyes had laxity of the entire length of the lower lid. Some eyes also had an associated ectropion. Among the 21 eyes, 4 eyes (22%) had Grade 1, 11 (61%) had Grade 2, 6 (17%) Grade 3 and none Grade 4 ectropion. In the lids with associated ectropion, additional procedures had been performed. In 1 eye, the medial canthus was anchored to the tendon and this patient had poor apposition of the lower lid to the globe. Hence, in the remaining 20 eyes, the medial canthus was anchored to the orbital periosteum. The mean change in eyelid length was 2.6 mm (measured from medial to lateral canthus) from pre-operative status (33+/-3.4 mm) to the post-operative status (30+/-2.9 mm) this being statistically significant. An overriding of the lower lid was seen in 2 eyes (10%), and a residual gap between the lower lid and globe was noticed in 15 (71%) eyes. Some eyes had uncorrected symptoms including epiphora (3 eyes; 14%), redness (2 eyes; 10%), and photophobia (1 eye; 5%). All were those in which the lateral end was lax. None had a recurrence of foreign body sensation. CONCLUSION: Plication is easy, effective and quick for correcting laxity of the lower lid when restricted predominantly to the medial end. Correct identification of anatomical landmarks and appropriate tension of sutures is vital to achieve proper apposition of the lower lid to the globe.     

The use of the superthinned inferior pedicled glabellar flap in reconstruction of small to large medial canthal defect

Medial canthal defects resulting from tumor resection are often too large to be closed directly because local tissue is in short supply. They can be repaired by using skin-muscle flaps or full-thickness skin graft to highlight a different technique, which may improve the cosmetic results achieved with this flap by reducing the tendency for the eyebrows to be drawn together.The superthinned inferior pedicled glabellar flap technique was used prospectively in 8 patients requiring medial canthal reconstruction.All patients were satisfied with the cosmetic and functional results. Photographs of all patients illustrate the preoperative and postoperative appearances of the eyebrows.This superthinned inferior pedicled glabellar flap technique is recommended to avoid drawing the eyebrows and bulky appearance in medial canthal region together when using the glabellar flap.     

Evaluation of the anatomical position of the lateral canthal ligament: clinical implications and guidelines.

Controversy exists in the literature as to the precise anatomical location of the lateral canthal ligament. The ligament is a 3 mm-wide, two-tailed band; its average length is approximately 13 mm, while the width of the rima palpebralis is about 26 mm. The authors evaluated three different groups to pinpoint the anatomical position of the ligament's attachment to the lateral orbital wall, and to establish guidelines for placement of the ligament during surgery. In 90% of the cases, the ligament was attached to Whitnall's tubercle, which is located approximately 4 mm posterior to the lateral orbital rim, and 17 mm above the intersection of the lateral and inferior margins; this area is 9 mm below the zygomaticofrontal suture. Based on these anatomical criteria, a standardized procedure is suggested.     

Paediatric medial epicondyle fractures of the distal humerus

Medial humeral epicondyle fractures represent approximately 12% of elbow injuries in children. It is a controversial topic in paediatric fracture management, as there is a trend towards extending the indications for surgical management that is not supported by high-quality evidence. In fact, the current literature can be contradictory and consists of mainly retrospective studies including small numbers of patients. The only absolute indication for surgery is when the medial epicondyle fragment becomes incarcerated within the elbow joint. In this article, we will present the important anatomical, physiological and interventional factors to allow independent interpretation of the literature. The current literature will be reviewed and a pragmatic approach to treatment presented. Due to the porosity of the current evidence on medial epicondyle fractures high-quality research is urgently required in the form of a adequately power definitive randomized control trial.     

Maxillofacial fractures related to work accidents

Work-related maxillofacial fractures were studied retrospectively over a six-year period. There were 98 cases accounting for 4.5% of all facial bone fractures treated in our hospital between 1981 and 1986. Of the patients, 89.8% were male. The mean age of the injured was 36.4 years. The incidence of work-related maxillofacial fractures was 0.37 per 1000 workers. Most of the injuries (66%) occurred in factories and construction work. Such work was associated with an to 15 times higher risk of maxillofacial fracture than service and office work. Of the fractures, 20.4% were sustained on the way to or coming from work. At the place of work, the commonest causes of injury were blows from objects or falls from a height (70%). On the way to or coming from work, the aetiological factor was most often a traffic accident. Assault and battery had caused facial bone fractures in 11.2% of cases. Fifty-five patients with midface and 45 patients with mandibular fractures were found, of these, 8 patients had bimaxillary fractures. In 6 cases, only dentoalveolar fractures were found. Of the patients, 55.1% were treated operatively. Sixty-six patients were hospitalized, the mean length of hospital stay being 3.2 days (range 1-12 days).     

Simultaneous reconstruction of medial canthal area and both eyelids with a single transverse split forehead island flap

In this report, we are presenting a case in which we have split the paramedian forehead flap, thus providing 2 axially perfused skin flaps for simultaneous reconstruction of the upper and lower lid structures after resection of basal cell carcinoma from the left medial canthal area. We found that split forehead flap seems to be a favorable option for simultaneous reconstruction of the upper and lower eyelid defects by enabling nicely vascularized and abundant amount of regional skin.     

Macroscopic anatomy of the sphenomandibular ligament related to the inferior alveolar nerve block

We performed macroscopic observations of the sphenomandibular ligaments, and measured the space that is surrounded by the mandibular ramus and the ligament by using computed tomography. The materials used in this study were 40 heads of 40 adult cadavers. The cadaver head was cut on the mid sagittal plane. The medial pterygoid muscles of the cadavers were removed to observe the ligaments. The attaching style of the sphenomandibular ligament to the mandibular ramus was classified into three types: Type I (5 in 40 samples; attached only to the mandibular lingula), Type II (12 in 40 samples; attached to the mandibular lingula and extended toward the rear part of the internal surface of the mandibular ramus), and Type III (23 in 40 samples; attached to the mandibular lingula and toward the posterior border of the mandibular ramus). There was no statistical difference in the length of the ligament among the three types. However, Type III showed the largest width, and the space was approximately eight and three times as large as those of Type I and II, respectively. This indicated that the Type III ligament covered a larger area over the mandibular foramen than Type I. These results suggest that the three-dimensional morphology of the sphenomandibular ligament, as represented by Type III, may affect the effectiveness of anesthesia.     

Anatomy of the lateral canthal tendon

OBJECTIVE: The purpose of this study was to clarify and describe the anatomy of the lateral canthal tendon. Knowledge of this anatomy is essential in selection of appropriate surgical procedures to restore orbital anatomy. STUDY DESIGN: Gross dissections were performed of the lateral orbital soft tissues from 21 preserved Caucasian cadaveric orbits. A block of the bony attachment of each lateral canthus was taken for histologic examination. After anatomical exposure, the following measurements of the lateral canthus were made: (1) the distance from the midpoint of insertion of the lateral canthus at the lateral orbit to the zygomaticofrontal suture; (2) the horizontal width of the lateral canthus, as measured from the lateral commissure to the lateral orbit; (3) the vertical difference in height between the medial canthal and lateral canthal insertions. RESULTS: The mean midpoint of the lateral canthus insertion was 10. 24 mm inferior to the zygomaticofrontal suture (range, 5-15 mm). The mean horizontal length of the lateral canthus from the lateral commissure to the lateral orbit was 7.52 mm (range, 2-12 mm). The mean vertical difference in height between the insertions of the medial canthus and the lateral canthus was 1.35 mm (range, -2-4 mm), the lateral canthus being at a more superior point. Histologic examination of hematoxylin-eosin-stained slides showed that the fibers of the lateral canthus inserted into the periosteum but not beyond it. CONCLUSIONS: The lateral canthal tendon attaches the upper and lower tarsal plates to Whitnall's tubercle inside the orbital rim deep to the septum. A precise knowledge of the periorbital anatomy will assist the surgeon in the selection of appropriate surgical techniques that will provide for restoration of this delicate anatomical configuration.     

Movement of fibroblasts in the periodontal ligament of the mouse incisor is related to eruption

Movement of fibroblasts in the periodontal ligament of the lower incisor of the mouse was studied by pulse-labeling with tritiated thymidine and proline. 3H-Thymidine was administered to mark the nuclei of the cells in the proliferative compartment near the basal end of the tooth; 3H-proline gave rise to a narrow band of radioactivity in the dentin, which served as a reference line for measurement of eruption. One or three weeks after injection in each animal, the lower right incisor was prevented from further eruption by being pinned to its alveolar process. The animals were killed 0, 1, or 2 weeks later, and their mandibles processed for LM-radioautography. It was found that in the left incisors, which were not inhibited in their eruption, labeled cells in the tooth-half of the periodontal ligament moved incisally at a rate similar to the eruption rate. In the pinned incisors, no further incisal migration could be established. It is concluded that fibroblast migration in the tooth-half of the ligament is strictly coupled to the eruptive process.     

Anthropometry of the Saudi Arabian nose

All previous studies on nasal anthropometry of Middle Eastern populations were done on Persian, Turkish, and North African populations; with no studies arising from the Arabic Gulf Region. This study aimed to define nasal anthropometric measurements in Saudi Arabia (the largest Arabic Gulf country) and compare them with different races. A total of 104 Saudi men and 105 Saudi women with a mean age of 22 years (range, 18-27 years) were included in the study. A total of 25 nasal anthropometric variables were measured. Comparison with other races was done using the t-test (P < 0.05 is considered significant). The intercanthal distance of Saudi men is significantly smaller than that in women (the reverse is true for other races). Hence, Saudi women (and not men) have significantly wider intercanthal distance than do whites. The nasal widths of Saudi men and women lie between the whites and the Chinese. A unique feature of the Saudi nose is the significantly larger nasofrontal angle of Saudi men and women compared with all other races. Within the Saudi race, the nasofacial angle of men is so much larger than that of women (41.4 vs 33.3 degrees). In other races, the difference between men and women is usually slight (0- to 1-mm difference only). In Saudi men, the nasofacial angle is significantly larger than that in whites, but the value for Saudi women is significantly smaller than that for whites. Finally, in both Saudi sexes, the nasal tip angle/nasal tip protrusion is significantly smaller than all other races. It was concluded that the Saudi nose has several unique features when compared with other races including other Middle Eastern populations.     

Endonasal endoscopic reduction of blowout fractures of the medial orbital wall.

PURPOSE: This article describes the endonasal endoscopic reduction (EER) of blowout fractures (BOFs) of the medial orbital walls and reports the clinical results. PATIENTS AND METHODS: Sixteen patients who underwent EER for a BOF of the medial orbital wall were analyzed. The surgical indications for treatment were diplopia, limitation of eye movements, and significant enophthalmos. They were followed-up for at least 3 months after the surgery. Surgical techniques, surgical results, and postoperative complications were reviewed. RESULTS: There were no significant intraoperative or postoperative complications. Fourteen patients showed complete resolution of symptoms after the surgery. One patient, who had persistent diplopia and remaining enophthalmos, underwent medial wall reconstruction with a Medpor surgical implant (Porex Surgical Inc, College Park, GA) by a transorbital approach. Another patient, who had residual enophthalmos, had correction of enophthalmos after insertion of a Medpor implant. Both patients are now symptom-free. CONCLUSION: The results indicate that EER is a safe and effective technique for the treatment of BOFs of the medial orbital wall.