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Head and Neck Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Warrenkevin Henderson, Hannah Jacobson, Noelle Purcell, Kylar Wiltz
Orbicularis oculi is comprised of orbital, palpebral, and lacrimal parts and a ciliary bundle (Standring 2016). The fibers of the orbital part form complete ellipses around the orbit and originate from the nasal part of the frontal bone, the frontal process of the maxilla, and the medial palpebral ligament (Standring 2016). These fibers form depressor supercilii (Macalister 1875; Standring 2016). The fibers of the palpebral part originate from the medial palpebral ligament, course across the eyelids, and end as the lateral palpebral raphe (Standring 2016). The fibers of the lacrimal part originate from the lacrimal bone and insert into the tarsi of the eyelids and the lateral palpebral raphe (Standring 2016).
Comparative Anatomy and Physiology of the Mammalian Eye
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
The musculature of the eyelids includes the muscles which close the eye, the orbicularis oculi, and those that open the eye, the levator palpebrae being the major muscle. A smooth muscle (Muller’s muscle) is found deep, extending along the course of the levator. It is under adrenergic innervation and results in a widened palpebral margin when stimulated. The orbicularis muscle fibers are arranged in bundles parallel to the free lid margin. The muscle is restricted in its circular sphincter action by restrictions in the nasal and temporal extremities. A firm attachment is accomplished by the medial palpebral ligament in all animals except the primate, which has a common tendon of the superficial heads of the pretarsal orbicularis oculi that inserts in the medial orbital wall. On the temporal side, the common tendon of the temporal pretarsal orbital axis assumes the function of the lateral ligament in primates, while in the other animals it is the retractor anguli muscle which serves this function. These structures allow the lid to close from laterally to medially, propelling tears to the medial aspect where the lacrimal puncta are found. The innervation to the eyelids includes sensory, motor, and autonomic portions. The sensory to the upper lid is the frontal branch of the ophthalmic division of the fifth cranial nerve, while the lower is the maxillary division of the fifth cranial nerve. Motor innervation is provided by the third (levator) and seventh (orbicularis) cranial nerves. The autonomic innervation is sympathetic to Muller’s and the smooth muscle of the third eyelid.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The tarsal glands are embedded in the posterior surface of each tarsal plate, the fibrous “skeleton” of the upper eyelid. The orbital septum is a sheet of connective tissue separating the superficial facial fascia and the contents of the orbit. The tarsal glands drain by orifices lying posteriorly to the eyelashes and secrete an oily substance onto the margin of the eyelids that prevents the overflow of tears (lacrimal fluid). The lacrimal gland lies in the lacrimal fossa of the frontal bone. The lacrimal sac lies posterior to the medial palpebral ligament, which is attached to the anterior lacrimal crest that forms the anterior border of the lacrimal groove (Plate 3.32). The lacrimal sac receives lacrimal fluid from the medial angle of the eye through the lacrimal canaliculi. When lacrimal fluid accumulates in excess and cannot be removed from the medial corner of the eye via the lacrimal canaliculi, it overflows the eyelids (visible crying or shedding of tears). Tears also drain into the nasal cavity via the lacrimal sac, resulting in a runny nose.
The use of lyophilized bovine pericardium (Tutopatch®) in the management of third nerve palsy following prior conventional strabismus surgery – a case series
Published in Strabismus, 2022
Mohamed Elabbasy, Sabine Naxer, Maren Horn, Michael P. Schittkowski
Hull et al.34 reported on 31 patients with large-angle incomitant exotropia, who underwent periosteal fixation of the MR and LR. Most of those patients had third nerve palsy and some had been previously operated on for strabismus. They discussed the benefit of this surgery on ocular alignment measured after a follow-up interval of 17 months. Their study revealed less reduction of deviation and more restriction of the ocular motility than after LR splitting. In our point of view, Tutopatch® tendon elongation would preserve the abduction and improve the alignment better than fixing the globe to the periosteum. Although, there were no reported serious complications, we find that suturing through the caruncle and both limbs of the medial palpebral ligament is a bit traumatizing.
Surgical success of ‘W’ shaped incision versus Tear Trough incision in External Dacryocystorhinostomy
Published in Orbit, 2022
Isha Acharya, Jolly Rohatgi, Pramod Kumar Sahu
Blunt dissection of subcutaneous tissues and orbicularis muscle in layers was carried out. The medial palpebral ligament (MPL) and periosteum overlying the anterior lacrimal crest were exposed. MPL was excised in all cases of Group W only. An adequate-sized osteotomy was made extending vertically from MPL to the proximal end of the nasolacrimal duct and anteriorly including the anterior lacrimal crest. The nasal cavity was then packed with ribbon gauze soaked with a local anaesthetic to elevate the nasal mucosa and also tamponade the bleeding mucosa. H-shaped flap of the lacrimal sac and nasal mucosa were formed. Both anterior and posterior flaps were sutured wherever possible with 6/0 Vicryl. 6/0 Vicryl was also used to suture the two cut ends of MPL. The skin incision was closed using interrupted 6/0 vicryl sutures. Intraoperative complications were recorded and managed simultaneously.
Angular artery island flap for eyelid defect reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Yavuz Keçeci, Zulfukar Ulas Bali, Anvar Ahmedov, Levent Yoleri
All operations were performed under general anesthesia with the patients in the supine position. Once the tumors were thoroughly examined and the excision borders were drawn, surgical resection was carefully carried out. All eyelid tumors were totally resected, leaving full-thickness eyelid defects. Ipsilateral angular artery-based island flaps were designed according to the defect location and size by using paper templates. The alar rim level was the inferior border of the flap where the flap harvesting started from. Incision deepened to the maxillary periosteum and dissection advanced subperiosteally to prevent angular vessels from inadvertent surgical damage since these vessels are very close to the periost. The lateral nasal artery was identified and coagulated on the medial side of the dissection. Subperiosteal dissection proceeded easily up to the medial palpebral ligament. As raising the flap, the angular vessels could be seen easily undersurface of the flap and the pedicle is released in a safe manner. After elevation of the flap, subcutaneous fat tissue was trimmed away while preserving the angular vessels under 2.5 magnifications. A tunnel was created under the orbicularis oculi muscle in cases where a medial portion of the eyelids was left intact and healthy.