The muscle of riolan represents the most superficial portion of the orbicularis muscle. Trillion dollar coach book bill campbell eric schmidt. Outer canthus, placed 5 mm laterally to the orbit margin1 or 34 mm medially to the whitnalls malar tubercle 3. Xxiv international symposium on morphological sciences. At whitnalls ligament the aponeurosis fans out to form the socalled horns. Of course, wikipedia definitively agrees that whitnalls ligament doesnt attach to whitnalls tubercle, for what thats worth 6. Jul 11, 2019 the preseptal muscles form the lateral palpebral ligament raphe, which inserts into whitnalls tubercle. No discussion of orbital anatomy would be complete without the mention of this anatomic landmark. The pretarsal muscle segments from both the upper and lower eyelids fuse laterally, forming the lateral canthal tendon that inserts onto the periorbital at whitnalls orbital tubercle. The eyelid skin is the thinnest in the body and unique in having no subcutaneous fat. There is bunching up of muscles on the lateral element.
The tendons are then severed from their attachments to whitnalls tubercle. Remember also that when the preaponeurotic fat is grasped and the septal attachments divided. Thus it is important to make good any loss of skin. Whitnalls ligament is an important suspensory structure for the superior orbit and eyelid and should not be cut. Internal cantholysis for full thickness eyelid defects sciencedirect. Lateral retinaculum an overview sciencedirect topics. Whether youve loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. Although whitnall s orbital tubercle could be readily identified as being higher than the attachments of the medial palpebral ligament, any change inrelationship between the orbital bones could not be found as an underlying cause. Dissection of the eyelid and orbit with modernised anatomical. Note that this is just anterior to the meibomian gland orifces, which come. The premaxilla is anterior and rotated to the non cs 7. The surgery involves removing redundant skin, fat, and muscle. The lateral canthal tendon is formed by two crura, which are continuous with the tarsal plates. Raw areas created on the skin surface by a variety of causes exposes the body to the harmful effects of these threats.
The attachment of septum orbitale follows the lower orbital margin. There is discontinuity of nasal floor or depression 3. Whitnalls tubercle is located within the lateral rim of the orbit below the frontozygomatic suture on the frontal process of the zygoma. The medial deep orbital insertion of the orbicularis muscle carries the orbital. Apr 25, 2020 from whitnalls ligament the muscle passes into its aponeurosis fig. Whitnalls tubercle no discussion of orbital anatomy would be complete without the mention of this anatomic landmark.
The lateral palpebral ligament attaches the lateral tarsus to whitnalls tubercle within the orbital rim. The anatomy of the lateral canthus and the surgical procedure are illustrated by gross dissection. The different techniques discussed in this book are easier to accomplish if the underlying anatomical principles are completely understood. Whitnall s tubercle serves as a common insertion point for a number of structures, which cumulatively are known as the lateral retinaculum. Atlas of aesthetic eyelid and periocular surgery pdf. Whitnalls tubercle is usually the location for reattachment during the lateral tarsal. The lateral confluence of the orbicularis oculi muscle becomes the lateral canthal tendon, which attaches laterally to whitnall s tubercle and suspends the lateral aspect of the. Other readers will always be interested in your opinion of the books youve read. This diagram demonstrates the conceptual split between the anterior lamella skin and orbicularis, right side and posterior lamella tarsus and conjunctiva, left side of the eyelid. Free medical textbook every people has explanation. The gray line, which is the muscle of riolan the most superficial aspect of the orbicularis muscle, is also shown. Whitnalls original text describing the tubercle doesnt list his eponymous ligament as one of the structures that attaches to it 5. Anterior to the lateral canthal tendon is a small pocket of. The osseous point at which the tendon attaches is called whitnalls tubercle.
Erzurumlu baltimoreusa professor of anatomy and neurobiology, university of. Relationships between the skull and the face for forensic. A case of traumatic retrobulbar hemorrhage is presented. Anterior to whitnalls ligament, the levator muscle passes into a thin, fibrous aponeurosis that turns inferiorly and fans out into the eyelid. At one point near zygomatic bone it leaves orbital margin and lies few mms away from it. Dissection of the medial ends of the lateral canthal tendon demonstrates the ligamentous attachments to the tarsal plates. Apr 01, 2002 traumatic retrobulbar hemorrhage may result in acute loss of vision that is reversible when recognized and treated promptly. Ligament definition of ligament by medical dictionary. Eye lid anatomy for ophthalmology residents, oculoplasty fellows.
Medially they end at the level of the lacrimal puncta. Buck, ii, is a oneofakind medical reference book designed to help you master the 20 most indemand operative techniques from plastic surgery, 3rd edition the definitive 6volume masterwork in plastic and reconstructive surgery. Features fullscreen sharing embed analytics article stories visual stories seo. This sheet continues downward 14 to 20 mm to its insertion near the marginal tarsal border. Traumatic retrobulbar hemorrhage may result in acute loss of vision that is reversible when recognized and treated promptly. The medial canthal tendon is composed of two heads. The skin and orbicularis, lid margin, conjunctiva, and lower lid retractors are removed from the excess eyelid laterally, creating a lateral tarsal strip which is then anchored to whitnalls tubercle inside the lateral orbital rim. Moorfields manual of ophthalmology pdf free download. The skin and orbicularis, lid margin, conjunctiva, and lower lid retractors are removed from the excess eyelid laterally, creating a lateral tarsal strip which is then anchored to whitnalls tubercle. Ophthalmonics is a term on my credit, created as a short form for ophthalmology mnemonics. Whitnalls tubercle is located within the lateral orbital rim 1 cm inferior to the zygomaticofrontal suture on the medial aspect of the frontal process of the maxilla.
Orbital fractures a physicians manual human anatomy. Bone attachments at sutures leave a mark on the periorbita when it is removed from. May 08, 2012 the technique of tarsal strip repair has been well described elsewhere. Quickaccess bulleted procedures, photos, and online. Whitnall s tubercle is located within the lateral rim of the orbit below the frontozygomatic suture on the frontal process of the zygoma. Comparison of left and right whitnalls tubercle and. From whitnall s ligament the muscle passes into its aponeurosis fig. Samuel ernest whitnall 18761950, professor of anatomy successively at mcgill university, montreal, canada, and bristol, uk. Thecribriform plate was deeply sunken between the orbital roofs, givingamoreoblique slope to the upperparts of. Medial attachments of the orbicularis oculi muscle. This chapter is a discussion of the anatomy of the face, with special emphasis on the eyelids, as it applies to cosmetic facial surgery. The superior transverse ligament of the eye also known as whitnall s ligament is a transverse ligament surrounding the levator palpebrae superioris muscle close to its partial implantation into the skin of the upper eyelid. In addition, supporting structures such as canthal tendons are tightened. Whitnalls ligament and the lateral horn of the aponeurosis attach onto the lateral orbital tubercle and contribute to the lateral canthal tendon.
The lateral canthus suspends the tarsus of both lids laterally to the zygomatic bone at whitnall s tubercle 1. Whitnall s tubercle is located within the lateral orbital rim 1 cm inferior to the zygomaticofrontal suture on the medial aspect of the frontal process of the maxilla. It rejoins the orbital margin just below the whitnalls tubercle. The latter fuses to the orbital wall near the trochlea and around the lacrimal gland. This book is distributed under the terms of the creative commons. Upper eyelid retractors american academy of ophthalmology. The orbicularis oculi muscle lies anterior to the tarsal plates and also has tendinous attachments to whitnalls tubercle. The medial canthal ligament has an anterior limb, which inserts anterior to the lacrimal crest, and a posterior limb, which inserts into the posterior lacrimal crest. A sound working knowledge of eyelid, orbital, nasal, and facial anatomy and the underlying neurovascular structures is essential. Whitnall s ligament is a check ligament of the levator muscle that. It is important as a marking point of attachment of the lateral check. Apr 04, 2014 the thick posterior portion of the lateral canthal tendon pl lct attaches to the orbital whitnalls tubercle of the zygoma, 3 to 4 mm posterior to the lateral orbital rim. The technique of tarsal strip repair has been well described elsewhere. Whitnall s ligament and the lateral horn of the aponeurosis attach onto the lateral orbital tubercle and contribute to the lateral canthal tendon.
This common canthal tendon inserts at whitnall s tubercle 2 to 3 mm inside the orbital rim. The anatomy of the lateral canthus and the surgical procedure are. The lateral canthal tendon is a fibrous attachment between the orbicularis oculi. Surgical anatomy fractures involving the orbit may give rise to alteration in the position of the globe of the eye. Fourth edition regional and applied dissection and clinical volume 3 head, neck and brain.
So it is not attached to the lateral orbital tubercle of whitnall. Whitnalls tubercle definition of whitnalls tubercle by medical. Whitnalls ligament is a check ligament of the levator muscle that. It serves as an attachment for the check ligament of the lateral rectus muscle, the lateral palpebral ligament, the suspensory ligament of lockwood and the levator.
It serves as an attachment for the check ligament of the lateral rectus muscle, the lateral palpebral ligament, the suspensory ligament of lockwood, and the levator. The lateral canthus suspends the tarsus of both lids laterally to the zygomatic bone at whitnalls tubercle 1. Although whitnalls orbital tubercle could be readily identified as being higher than the attachments of the medial palpebral ligament, any change inrelationship between the orbital bones could not be found as an underlying cause. The preseptal muscles form the lateral palpebral ligament raphe, which inserts into whitnalls tubercle. The lateral horn of the levator aponeurosis is strong, and it divides the lacrimal gland into orbital and palpebral lobes, attaching firmly to the orbital tubercle. The thick posterior portion of the lateral canthal tendon pl lct attaches to the orbital whitnalls tubercle of the zygoma, 3 to 4 mm posterior to the lateral orbital rim. The superior transverse ligament of the eye also known as whitnalls ligament is a transverse ligament surrounding the levator palpebrae superioris muscle close to its partial implantation into the skin of the upper eyelid. Posted on 19052016 19052016 by dr saikat saha introduction skin is the primary protective barrier of the body against external mechanical, chemical or biological threats.
The levator muscle and aponeurosis are invested loosely by orbital fat anteriorly until the aponeurosis fuses with the orbital septum at or above its insertion at the tarsus. Blepharoplasty is an operation to modify the contour and configuration of the eyelids in order to restore a more youthful appearance. Whitnalls tubercle a small elevation on the orbital surface of the zygomatic bone just behind and within the orbital margin, about 11 mm below the frontozygomatic suture. Xxiv international symposium on morphological sciences, 2nd6th september, 2015, istanbul, turkey. Designers marketers social media managers publishers. In 90% of the cases, the ligament was attached to whitnalls tubercle, which is located approximately 4 mm posterior to the lateral orbital rim, and 17 mm above the intersection of the lateral and.
Located on the lateral orbital wall just inferior to the frontozygomatic suture and approximately 1 cm posterior to the lateral orbital rim is a protuberance that whitnall indicated was present in 96% of the specimens he. Posted on 19052016 19052016 by dr saikat saha introduction. Tether the tarsi to the periostium medially and laterally. 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. Skin is the primary protective barrier of the body against external mechanical, chemical or biological threats. The lateral ends are 7 mm from the whitnalls tubercle. The medial horn of the aponeurosis is more delicate and forms loose connective attachments to the posterior aspect of the medial canthal tendon and to the posterior lacrimal crest.
Anatomy of the eyelids eyelid diseases central lakes medical. The lower tarsus is 5 mm in size and is oblong in shape. The thinner anterior fibers course laterally to mingle with the orbicularis oculi muscle fibers and the periosteum of the lateral orbital rim. Thieme ejournals seminars in plastic surgery full text. This, along with the color match, makes the upper eyelid an ideal donor site for a small fullthickness skin graft to be used for lower eyelid reconstruction. Pdf fourth edition regional and applied dissection and. The muscle also attaches to the superior tarsal plate and into orbital bone the ligament allows for a change of the functional origin of the levator palpebrae. It serves as an attachment for the check ligament of the lateral rectus muscle, the lateral palpebral ligament, the suspensory ligament of lockwood and the levator palpebrae superioris muscle. The aponeurotic fibers are most firmly attached at about 3 to 4 mm above the eyelid margin 10,11. This point is equivalent to the whitnalls tubercle approximately 1 cm inferior to the frontozygomatic suture and approximately 45 mm behind the lateral orbital rim, where attached are the. Whitnalls orbital tubercle tuberculum orbitale whitnall, a small elevation on the orbital margin of the zygomatic bone that is found in 95 % of people, localizes 11 mm below the frontozygomatic suture and 45 mm behind the orbital margin 4.
At whitnall s ligament the aponeurosis fans out to form the socalled horns. Anisocoria noted at age 14 months in otherwise healthy infant. So here the septum forms osteofibrous pocket called premarginal recess of eisler. Whitnalls ligament runs horizontally from the trochlea to whitnalls tubercle and acts as a pulley for the levator. Photograph at age 6 months confirms chronicity and benign nature of finding. Diagnostic atlas of common eyelid diseases jonathan j. This posterior attachment vector is an important consideration during lid tightening procedures involving the lateral canthal ligament. This important anatomical landmark is connected to. Consistency of the lateral canthus as an anatomic landmark. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the. Paul riordaneva a thorough understanding of the anatomy of the eye, orbit, visual pathways, upper cranial nerves, and central pathways for the control of eye movements is a prerequisite for proper interpretation of diseases having ocular manifestations. The technique of emergent orbital decompression by lateral canthotomy and cantholysis is described. Whitnalls tubercle 18 is a small protuberance of the. The lateral confluence of the orbicularis oculi muscle becomes the lateral canthal tendon, which attaches laterally to whitnalls tubercle and suspends the lateral aspect of the.