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Location and Tension of the Medial Palpebral Ligament

Hwang, Kun MD, PhD*; Huan, Fan MS, RN*; Nam, Yong Seok PhD; Han, Seung Ho MD, DMSc; Kim, Dae Joong PhD

doi: 10.1097/SCS.0b013e31827c7c3e
Anatomical Studies

The aim of this study was to elucidate the precise anatomic location and tension of the medial palpebral ligament (MPL). Eleven hemifaces of 10 fresh Korean adult cadavers were used in this study. Nine specimens were used for measurement of dissection and tension, and 2 were used for histologic study. Measurements of tensile strength of each part of the MPL and Horner muscle were performed using a force gauge.

The MPL consisted of 2 layers in all specimens dissected. The superficial layer of the palpebral ligament (SMPL) was observed from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. The Horner muscle was observed at the posterior lacrimal crest just lateral to the attachment of the DMPL and ran laterally to the tarsal plate deep to the SMPL. The SMPL began at 4.5 ± 2.3 mm lateral to the nasomaxillary suture line to the upper and lower tarsal plates. Its transverse length was 9.6 ± 1.5 mm, and vertical width was 2.4 ± 0.7 mm, and its thickness was 4.5 ± 2.3 mm. The transverse length of the DMPL was 3.7 ± 0.4 mm, and its vertical width was 2.9 ± 1.3 mm, with a thickness of 0.3 ± 0.1 mm. The transverse length of the Horner muscle was 7.6 ± 1.9 mm, and its vertical width was 4.06 ± 1.5 mm, with a thickness of 0.4 ± 0.1 mm. The tensile strength of the SMPL was 13.4 ± 3.2 N, that of the DMPL was 4.1 ± 1.7 N, and that for Horner muscle was 9.0 ± 3.1 N. The tensile strength of the SMPL was significantly higher than that of the DMPL (P = 0.003).

We reconfirmed that the MPL consisted of 2 layers: superficial layer and deep layer. Our results might be of use in surgeries of the medial canthi.

From the *Department of Plastic Surgery and Center for Advanced Medical Education by BK21 Project, Inha University School of Medicine, Incheon; †Department of Anatomy and Institute for Applied Anatomy, Catholic University of Korea, Seoul; and ‡Department of Anatomy, and Center for Advanced Medical Education by BK21 Project, Inha University School of Medicine, Incheon, Korea.

Received August 20, 2012.

Accepted for publication November 4, 2012.

Address correspondence and reprint requests to Kun Hwang, Department of Plastic Surgery, and Center for Advanced Medical Education by BK21 Project, Inha University School of Medicine, 7-206 Sinheung-dong, Jung-gu, Incheon, 400-711, Republic of Korea; E-mail: jokerhg@inha.ac.kr

This work was supported by a grant from the Inha University (INHA Research Grant).

The authors report no conflicts of interest.

© 2013 by Mutaz B. Habal, MD.