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PubMed1995

Distribution and cycle phase dependency of gonadotropin receptors in musculature and blood vessels of the porcine broad ligament.

Luteinizing hormone (LH) and human chorionic gonadotropin (hCG) share common receptors in the uterus of many species. The aim of the present work was to investigate the possibility of LH/hCG binding sites present in the musculature of the porcine broad ligament, and to study the topography of LH/hCG receptors in ligamental blood vessels. Uteri of cyclic pigs were collected during follicular (n = 6) and midluteal (n = 6) phases of the estrous cycle. The horns and broad ligaments were dissected for measurements of numbers and affinities of unoccupied LH/hCG binding sites in crude cell membrane fractions of the myometrium and the smooth muscle layers of the ligament. The tissue samples for contact autoradiography, on film using [125I]hCG as ligand, were collected from different regions of the reproductive tract including: ovary, uterine horn, paraovarian vascular plexus, uterine vein, and uterine artery with supplying vessels and the outer arches of the broad ligament. The kidney and liver were used as negative control tissue. The specific binding of [125I]-labelled hCG in blood vessels was quantified on the base of optical density of the film. Scatchard analysis of data from broad ligamental and myometrial crude membrane preparations gave comparable estimates of the association constants and numbers of LH/hCG receptors. Mean concentrations (+/- SEM) of receptors (nmol/kg protein) were lower in the broad ligament than in the myometrium (p < 0.05) during both follicular and luteal phases (2.2 +/- 0.5 vs. 1.0 +/- 0.3 and 2.5 +/- 0.5 vs 1.7 +/- 0.2; respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

3.0 T high-resolution MR imaging of carpal ligaments and TFCC.

PURPOSE: To determine the diagnostic value of 3.0 Tesla MRI for imaging carpal ligaments and triangular fibrocartilage complex (TFCC). Image quality of different optimized MRI sequences is evaluated for high resolution wrist anatomy. MATERIALS AND METHODS: Ten healthy volunteers were examined at 3.0 T and 1.5 T using following sequences: T1 SE, fat-saturated PD-/T2-TSE, TIRM, 3D T1/T2* DESS, 3D-CISS, 2D and 3D T2* MEDIC. Voxel size varied from 0.2 x 0.2 x 1.5 mm (2D sequences) to 0.33 mm (3) and 0.26 mm (3) (3D sequences). Image quality (signal-to-noise-ratio, contrast-to-noise-ratio, artifacts) and carpal ligament/TFCC detection rate were judged by a score. The results obtained from the 3.0 T and 1.5 T devices were compared. RESULTS: With identical voxel size, image matrix and FOV, 3.0 T MRI provided significantly better image quality and ligament detection rates for all sequences in comparison with 1.5 T. The 2D and 3D MEDIC sequences yielded best image quality and detection rates. Excellent image quality and visualization of ligament structures by the fat-suppressed PD-TSE sequence were compromised by a relatively high susceptibility to pulsation and motion artifacts. T1 SE and 3D DESS sequences gave moderate image quality and allowed only partial differentiation between ligament structures. TIRM, T2-TSE and 3D-CISS sequence proved to be unsuitable for examining ligaments at 3.0 T due to their poor image quality and detection rate. CONCLUSION: 3.0 T MRI of the wrist proved to be superior to 1.5 T MRI for high-resolution imaging of carpal ligaments and TFCC using 2D and 3D T2* MEDIC sequences. Clinical studies investigating ligament injuries or carpal instability are recommended for evaluating clinical relevance of high-resolution MRI of the wrist.

Cartilage, Articular↗
PubMedDate not supplied

Evaluation of collateral ligament injuries of the metacarpophalangeal joints with magnetic resonance imaging and magnetic resonance arthrography.

Injuries of the collateral ligaments of the metacarpophalangeal (MCP) joints of the hand require accurate diagnosis and prompt treatment to prevent loss of function. The most common and well-known collateral ligament injury is injury to the ulnar collateral ligament of the first MCP joint of the hand, often referred to as a gamekeeper injury. Although less common, injuries involving the collateral ligaments of the second through fifth digits and the radial collateral ligament of the first digit also occur. The diagnosis of collateral ligament injury is often made clinically, however, magnetic resonance imaging and magnetic resonance arthrography of the MCP joints can be very useful in the evaluation of severity of the injury. This provides important information for the hand surgeon and aids in treatment planning. Imaging of the collateral ligaments requires small fields of view and several technical considerations can provide improved image quality. These factors will be discussed and illustrated in this article.

Arthrography↗
PubMedDate not supplied

Role of collateral ligaments in the GSB-linked total elbow prosthesis.

The GSB III elbow prosthesis is a loose-hinged type of elbow implant. The introduction of such hinged elbow arthroplasty expanded the indications for elbow replacement to patients with more deficient bone and ligaments. The purpose of this study was to compare the kinematics and stability of the GSB III elbow prosthesis with that of the normal elbow and to investigate the role of the collateral ligaments in the kinematics and the stability of the GSB III total elbow prosthesis in an in vitro model. The results could show a semiconstrained kinematic pattern of the GSB III implant. The mean laxity for varus/valgus stress of the implant without collateral ligament support was significantly greater for all flexion angles when compared with intact elbows (mean, 12.7 degrees versus 5.4 degrees ) and with elbows treated with a standard implantation technique (mean, 9.5 degrees ). The release of the collateral ligaments increased the already observed varus shift after standard implantation of a GSB III elbow prosthesis. The laxity measured without collateral ligaments during loaded movement reached the maximum varus/valgus laxity of the GSB III prosthesis of 12 degrees degrees. The study confirms the role of the collateral ligaments in stabilizing the GSB III elbow prosthesis. Missing collateral ligaments may overload the implant-cement-bone interface and may be one factor contributing to early aseptic loosening of this device.

Aged↗
PubMed2002

Mechanoreceptors and length of the patellar ligament after Ho-YAG laser treatment: a long-term follow-up in rabbits.

We studied the shortening and the number of mechanoreceptors in the patellar ligament up to 18 months after Ho-YAG irradiation of the ligament's surface in 35 rabbits. The ligaments shortened an average 13% immediately after irradiation. After treatment, we divided the rabbits into a mobilized or immobilized group. At 2 weeks and 12 months after treatment both groups showed no shortening of the ligament, as compared to the intact ligament while that in the mobilized group had elongated at 12 months. Fewer Pacinian and Ruffini corpuscles were found in the irradiated ligaments than in the intact ones at 2 weeks after treatment, but we found no difference between irradiated and intact ligaments at 18 months after treatment.

Animals↗
PubMed2005

Anterior cruciate ligament constructs fabricated from human mesenchymal stem cells in a collagen type I hydrogel.

BACKGROUND: Disruptions of the anterior cruciate ligament (ACL) of the knee joint are common and are currently treated using ligament or tendon grafts. In this study, we tested the hypothesis that it is possible to fabricate an ACL construct in vitro using mesenchymal stem cells (MSC) in combination with an optimized collagen type I hydrogel, which is in clinical use for autologous chondrocyte transplantation (ACT). METHODS: ACL constructs were molded using a collagen type I hydrogel containing 5 x 10(5) MSC/mL and non-demineralized bone cylinders at each end of the constructs. The constructs were kept in a horizontal position for 10 days to allow the cells and the gel to remodel and attach to the bone cylinders. Thereafter, cyclic stretching with 1 Hz was performed for 14 days (continuously for 8 h/day) in a specially designed bioreactor. RESULTS: Histochemical analysis for H and E, Masson-Goldner and Azan and immunohistochemical analysis for collagen types I and III, fibronectin and elastin showed elongated fibroblast-like cells embedded in a wavy orientated collagenous tissue, together with a ligament-like extracellular matrix in the cyclic stretched constructs. No orientation of collagen fibers and cells, and no formation of a ligament-like matrix, could be seen in the non-stretched control group cultured in a horizontal position without tension. RT-PCR analysis revealed an increased gene expression of collagen types I and III, fibronectin and elastin in the stretched constructs compared with the non-stretched controls. DISCUSSION: In conclusion, ACL-like constructs from a collagen type I hydrogel, optimized for the reconstruction of ligaments, and MSC have been fabricated. As shown by other investigators, who analyzed the influence of cyclic stretching on the differentiation of MSC, our results indicate a ligament-specific increased protein and gene expression and the formation of a ligament-like extracellular matrix. The fabricated constructs are still too weak for animal experiments or clinical application and current investigations are focusing on the development of a construct with an internal augmentation using biodegradable fibers.

Animals↗
PubMed1991

Quantitative anatomy of cervical spine ligaments. Part II. Middle and lower cervical spine.

The quantitative anatomy of the ligaments of the middle and lower cervical spine was determined from six human cadaveric specimens using stereophotogrammetry. For each of the ligaments--anterior longitudinal, posterior longitudinal, capsular, ligamentum flavum, interspinous, and supraspinous--the origins, lengths, and orientations were defined three-dimensionally. The anterior and posterior longitudinal ligaments were approximately 7.5 mm wide and 12 mm long at levels C3 through T1, whereas only 3.8 mm wide but 23 mm long and 31 mm long at C1-C2, respectively. The capsular ligaments were fairly constant at all levels, oriented posteriorly at approximately 45 degrees to the transverse plane. The ligamentum flavum were relatively constant in width (5 mm), whereas their lengths increased from 5.2 mm at C2-C3 to 8.7 mm at C7-T1. The interspinous ligament was tilted anteriorly 30-40 degrees and was shortest at levels C2-C3 and C3-C4. The supraspinous ligament was more vertically oriented than the interspinous ligament by 15-20 degrees.

Adult↗
PubMedDate not supplied

Strain gauge analysis of knee ligaments.

Mercury strain gauges were sutured onto the tibial collateral anterior and posterior cruciate ligaments to quantitatively determine the relative strain or deformation of each of these ligaments as a function of joint position. The results were obtained on 5 amputation specimens by subjecting them to flexion, extension, rotation, valgus--varus and anteroposterior forces. The tibial collateral ligament is most lax in full flexion and stretches with extension, valgus and external rotation. The cruciate ligaments are most lax at 35 degrees flexion and stretch with both flexion and extension. Internal rotation and varus stretch and anterior cruciate ligament. These principles allow us a better understanding of injury patterns. The most advantageous position for immobilization following acute injuries or reconstructions is better understood knowing that minimal tension on ligamentous fibers occurs as follows: Anterior cruciate, 35 degrees; Posterior cruciate, 35 degrees; Tibial collateral ligament, 45--90 degrees (or as much flexion as the patient will tolerate).

Biomechanical Phenomena↗
PubMed1996

Influence of steroid injection on ligament healing in the rat.

The effect of a single local injection of long acting corticosteroid on the healing of acute rat medial collateral ligament injuries was studied. The medial collateral ligaments of 81 adult female rats were exposed surgically. In 32 rats, the ligament was transected sharply, the overlying muscle was closed, and a human equivalent dose of dexamethasone was injected under the muscle layer, bathing the injured ligament. The identical operation with no corticosteroid injection was done in 32 additional rats: in the remaining 17 animals, the incision was closed without ligament transection or injection. The rats were divided into 3 groups of 25. Each group consisted of 10 rats that were injected, 10 that were not injected, and 5 that underwent sham operations. One group was euthanized 6 days after surgery, 1 group after 10 days, and 1 group after 20 days. Histologic evaluation and biomechanical testing were performed for each subgroup. A cellular pathologist examined a smaller group of 6 rats (2 from each group) for histologic changes 40 days after surgery. No histologic differences were noted between the injected and noninjected ligaments 6, 10, or 20 days after injury. At 40 days, the injected specimens showed a slightly more mature crimp pattern than the noninjected specimens. Mechanical testing demonstrated no significant difference in ultimate load or ultimate stress between the injected and noninjected groups. There were no detrimental effects of a single dose administration of dexamethasone on the histologic appearance or biomechanical strength of healing rat medial collateral ligaments.

Animals↗
PubMed1998

Tensile load and the metabolism of anterior cruciate ligament cells.

It generally is recognized that tensile load plays a major role in maintaining the homeostasis of the anterior cruciate ligament fibers, but its detailed mechanism remains a matter of controversy. The effect of cyclic tensile load on the metabolism of the anterior cruciate ligament were investigated experimentally using cultured cells from the anterior cruciate ligament of rabbits. Using culture plates with flexible rubber bases, a cyclic tensile load was applied to the cultured cells for 24 hours, and the changes in shape, alignment, and metabolism of the cells were analyzed. Under the cyclic tensile load, the shape of the cells from the anterior cruciate ligament changed to spindle and aligned perpendicularly to the direction of the tensile load. The cyclic tensile load also caused an increase in collagen synthesis by the cells from the anterior cruciate ligament, which was predominant in Type I. The cells from the synovium showed similar changes in shape and alignment under the cyclic tensile load, but no significant change was observed in cell metabolism. These observations suggest that the application of cyclic tensile load on the anterior cruciate ligament cells is an important factor in the regulation of collagen synthesis in the anterior cruciate ligament.

Animals↗
PubMed1999

Posterior cruciate ligament effects on the flexion space in total knee arthroplasty.

Twelve fresh frozen anatomic specimen knees were used in this study to measure changes in the tibiofemoral joint gaps after sacrificing the posterior cruciate ligament. Joint gap changes were measured using a motion tracking device in full extension and at 45 degrees and 90 degrees flexion. Tibiofemoral gaps were measured with no external compressive loads and under tension to define the flexion gap, the space available to be filled by components. After initial anterior cruciate ligament removal, meniscectomy, and a 1-cm tibial plateau cut, sacrifice of the posterior cruciate ligament caused significant differences in the flexion gap. At 90 degrees flexion the tibia distracted from the femur 5.26 +/- 1.9 mm (range, 3.2-9.1 mm) at rest and 6.4 +/- 2.5 mm under tension. No differences in the joint space were calculated in full extension under either loading case. The authors conclude that a major result of posterior cruciate ligament sacrifice is the creation of a larger flexion gap. This result provides insight into relative joint line changes that can occur after posterior cruciate ligament sacrifice. It also suggests the need for greater attention to flexion stability when sacrificing the posterior cruciate ligament and rethinking the role of posterior cruciate ligament release in the management of pure, primary flexion contracture.

Aged↗
PubMed2000

Anterior cruciate ligament injuries in the female athlete. Potential risk factors.

In the general population, an estimated one in 3000 individuals sustains an anterior cruciate ligament injury per year in the United States, corresponding to an overall injury rate of approximately 100,000 injuries annually. This national estimate is low for women because anterior cruciate ligament injury rates are reported to be two to eight times higher in women than in men participating in the same sports, presenting a sizable health problem. With the growing participation of women in athletics and the debilitating nature of anterior cruciate ligament injuries, a better understanding of mechanisms of injury in women sustaining anterior cruciate ligament injuries is essential. Published studies strongly support noncontact mechanisms for anterior cruciate ligament tears in women, which make these injuries even more perplexing. Speculation on the possible etiology of anterior cruciate ligament injuries in women has centered on anatomic differences, joint laxity, hormones, and training techniques. Investigators have not agreed on causal factors for this injury, but they have started to profile the type of athlete who is at risk. In the current study the most recent scientific studies of intrinsic and extrinsic risk factors thought to be contributing to the high rate of female anterior cruciate ligament injuries will be reviewed, important differences will be highlighted, and recommendations proposed to alleviate or minimize these risk factors among female athletes will be reported where appropriate.

Anterior Cruciate Ligament Injuries↗
PubMed2004

Role of the coracoacromial ligament as restraint after shoulder hemiarthroplasty.

Patients with an irreparable rotator cuff tear and glenohumeral degeneration often are treated with hemiarthroplasty. This procedure has proven effective as long as the coracoacromial ligament remained intact. The ligament reportedly acts as a restraint against anterosuperior dislocation. The purpose of the current study was to test the role of the coracoacromial ligament as an anterosuperior restraint after hemiarthroplasty in shoulders from cadavers with simulated irreparable rotator cuff tears. Six fresh-frozen shoulders were dissected to mimic a massive rotator cuff tear. After a hemiarthroplasty was done, each shoulder was mounted in a fixture, which was attached to a materials testing device. Using this device, the role of the coracoacromial ligament was evaluated by loading the shoulders in various positions and then measuring displacement before and after excision of the ligament. The mean difference in anterosuperior displacement was 3.44 mm. In all shoulders, subjective observation revealed that the humeral head often becomes wedged between the coracoid and the acromion during axial loading after excision of the coracoacromial ligament. Therefore, the coracoacromial ligament should be preserved to enhance the stability of the joint and to preserve the superior fulcrum.

Adult↗
PubMed2006

The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study.

OBJECTIVES: The Lauge-Hansen classification system was designed to predict the mechanism and ligament injury patterns of ankle fractures on the basis of x-rays. The purpose of this study was to evaluate the accuracy of these predicted injury sequences using magnetic resonance imaging (MRI) in a series of patients with ankle fractures. DESIGN: Retrospective cohort. SETTING: Two university level 1 trauma centers. PATIENTS: Fifty-nine patients with operative ankle fractures who were evaluated with both x-ray and MRI were included. INTERVENTION: All patients had a standard 3-view ankle x-ray series before fracture reduction, followed by an MRI. All plain x-rays were assigned to a Lauge-Hansen category by an experienced orthopedic traumatologist. MRI studies were subsequently read by an MRI musculoskeletal radiologist for the integrity of the ankle ligaments. MAIN OUTCOME MEASUREMENTS: After evaluation of the x-rays, fractures were classified according to the system of Lauge-Hansen, and the predicted presence, sequence, and mechanism of injury was determined. These were then compared to the actual injured structures on MRI in each case, and the ability of the Lauge-Hansen system to accurately predict the complete injury pattern was determined for the entire cohort. RESULTS: Average patient age was 59 (range: 18 to 84) years. Of the 59 ankle fractures evaluated, 37 (63%) were classified as supination external rotation, 11 (19%) were pronation external rotation, 1 (2%) was supination adduction, and 10 (17%) were not classifiable on the basis of the Lauge-Hansen system. Of the 49 fractures that fit into Lauge-Hansen categories, 26 (53%) had patterns of ligamentous injury and fracture morphology that did not coincide with the Lauge-Hansen predictions. A common fracture pattern was observed in 8 of the 10 unclassifiable fractures, which included a high spiral fracture of the fibula, vertical shear fracture of the medial malleolus, posterior malleolar fracture, and complete tears of the anterior-inferior tibiofibular ligament and the interosseous membrane. In addition, over 65% of patients in this series had complete ligamentous injury and a fracture of the malleolus to which the ligament attaches. CONCLUSIONS: These results demonstrate that the Lauge-Hansen classification system may have some limitations as a predictor of the mechanism of injury and the presence of soft-tissue damage associated with ankle fractures. The identification of a novel pattern of ankle fracture also illustrates how the system fails to describe all possible fracture patterns. For these reasons, we recommend that the Lauge-Hansen system be used only as a guide in the diagnosis and management of ankle fractures and not solely relied upon for treatment decisions. Although the exact clinical implications of the variety of ligamentous injuries observed on MRI are yet to be determined, this technique may be useful in individual cases in which doubt about joint stability and soft-tissue integrity exists. Additionally, MRI may be helpful in planning surgical approaches in atypical fractures in which injury patterns are less predictable solely on the basis of x-ray.

Adolescent↗
PubMed1989

The retaining ligaments of the cheek.

The zygomatic ligaments (McGregor's patch) anchor the skin of the cheek to the inferior border of the zygoma just posterior to the origin of the zygomaticus minor muscle. The mandibular ligaments tether the overlying skin to the anterior mandible. Both these ligaments are obstacles to surgical maneuvers intended to advance the overlying skin. They also restrain the facial skin against gravitational changes, and they delineate the anterior border of the "jowl" area. The platysma-auricular ligament is a thin fascial sheet that extends from the posterosuperior border of the platysma and that is intimately attached to the periauricular skin; it serves as a surgical guide to the posterosuperior border of the platysma. The anterior platysma-cutaneous ligaments are variable fascial condensations that anchor the SMAS and platysma to the dermis. They can cause anatomic disorientation with dissection of false planes into the dermis. These four ligaments are useful as anatomic landmarks during facial dissections. The tethering effects of the zygomatic and mandibular ligaments must be interrupted if a maximum upward movement of the facial skin is desired.

Cheek↗
PubMed2002

Cleland's ligaments: an anatomic study.

The anatomy and function of Cleland's ligaments--thought by the authors to require clarification because of the conflicting anatomic descriptions in the literature--are reviewed. A statistical representation of the structure of these ligamentous bundles was derived from the study of 16 fixed human cadaveric digits and five fresh cadaveric digits, all from different patients. The results demonstrate a large variation in anatomy. However, this anatomic heterogeneity is not indicative of an equally varied function. In general, it was found that the majority of Cleland's ligaments traversed a great distance adherent to the skin before actually inserting in the dermis. Over one-third of the dorsal fibers demonstrated a multiplanar organization, fanning out before inserting into the skin. In contrast, the ventral fibers did not fan out before inserting into the skin. Excision of these ventral fibers revealed a separate "ledgelike" plane of fibers arising from the fibrous flexor sheath and running in a straight line perpendicular to the long axis of the digit. A branch of the digital nerve was found to pierce this ligamentous layer in the majority of digits studied. Unlike those of previous reports, the results of the present study suggest that the ligaments have a constant function of anchoring the skin of the digit on both the dorsal and ventral aspects, thereby preventing the displacement of skin during flexion of the digits. All previous studies failed to make this conclusion. The anatomic relationship to the digital neurovascular bundle also suggests that Cleland's ligaments may stabilize the digital vessels during flexion. In conclusion, Cleland's ligaments are highly functional structures and are essential for normal cutaneous stability during digital movements.

Female↗
PubMed2002

Comparison of partial excision with simple section of the transverse carpal ligament in the treatment of carpal tunnel syndrome.

In the surgical treatment of carpal tunnel syndrome, debate has commonly focused on whether decompression should be performed by open or blind techniques. Contrarily, the goal of the present study was to determine whether instead of simple section, partial excision of the transverse carpal ligament has contributed to better results. Because complete healing of the transverse carpal ligament observed during reoperations has been reported elsewhere, the charts of 75 carpal tunnel syndrome patients who had been treated with open technique at Dokuz Eylül University were reviewed. Statistical analysis was performed using the Fisher's exact test and Student's t test when appropriate. Thirty-five patients had been treated with simple section of the transverse carpal ligament, whereas 40 had been treated with partial excision. Internal neurolysis was also performed in 19 of the patients, 11 of whom were treated with partial excision. The average follow-up time was 3.8 years. The comparisons regarding the overall operative outcomes did not show any significant difference between the two different techniques of releasing the transverse carpal ligament. In patients treated without neurolysis, results of partial excision of the transverse carpal ligament improved when compared with those of simple section, but this superiority was not statistically significant. There seemed to be statistically higher reoperation rates and worse outcomes after neurolysis (p < 0.05). Reoperation was required in eight patients (11 percent). Five of the patients who underwent reoperation had initially been treated with partial excision and neurolysis, whereas two had been treated with simple section and neurolysis. Another patient who had undergone reoperation had initially undergone only simple section. The mean time to return to work or daily activities did not differ between the types of applied technique for releasing the transverse carpal ligament. However, neurolysis lengthened these periods significantly when performed (p < 0.05). In the present study, partial excision of the transverse carpal ligament without adding neurolysis offered relatively better results than simple section. Verification of this finding endoscopically, if applicable, may improve the success rate of surgical therapy in patients with carpal tunnel syndrome.

Adult↗
PubMed2002

Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus.

Description of the surgical anatomy of the superficial fascia of the face must include its deep attachments. These attachments have been mapped out for the forehead, temple, and cheek as retaining ligaments. The deep attachments of the orbicularis oculi of the lower lid and lateral canthus have long been recognized in canthopexy surgery but have yet to be properly defined. Six fresh cadavers were dissected with histologic support, and the results were correlated with surgical observations. The fascia of the deep aspect of the orbicularis is attached to the periosteum of the orbital rim by an orbicularis retaining ligament. This attachment is weakest centrally and tightest over the inferolateral orbital rim. The retaining ligament fuses with an expanded fibrous attachment beyond the lateral canthus, the lateral orbital thickening, which extends over the lateral orbital rim onto the adjacent deep temporal fascia. Aging changes are associated with attenuation of the ligamentous support provided by the orbital thickening and the orbicularis retaining ligament, which then allows inferior displacement of the lower boundary of the lid and contributes to the typical effects of age in this region. The superficial fascia of the lateral orbital region has a continuous connective tissue structure linking the temporoparietal fascia and orbicularis fascia to the lateral canthal tendon by means of the tarsal plate connection. Release of the deep ligamentous attachments (lateral orbital thickening and orbicularis retaining ligament) of the orbicularis fascia is important in some canthopexy and in rejuvenation procedures. The release allows effective redraping and upward mobilization of the orbicularis of the lower lid and the premalar soft tissues.

Aged↗