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Aponeurosis of the levator palpebrae superioris in Chinese subjects: A live gross anatomy and cadaveric histological study.

Pan E, Nie YF, Wang ZJ, Peng LX, Wu YH, Li Q - Medicine (Baltimore) (2016)

Bottom Line: An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer.The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA.An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin.

View Article: PubMed Central - PubMed

Affiliation: aSouthern Medical University bDepartment of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command of PLA cAesthetic Plastic Surgery, Hospital of the San Yet-Sun Medical University, Guangzhou dLOMEYE Medical Beauty Clinic, Beijing, China.

ABSTRACT
An accurate understanding of the anatomy of the levator palpebrae superioris aponeurosis (LPSA) is critical for successful blepharoplasty of aponeurotic ptosis. We investigated the macroscopic and microscopic anatomy of the LPSA.This prospective live gross anatomy study enrolled 200 adult Chinese patients with bilateral mild ptosis undergoing elective blepharoplasty. Full-thick eyelid tissues and sagittal sections from the eyelid skin to the conjunctiva were examined with Masson trichrome staining or antismooth muscle actin (SMA) immunohistochemistry.Gross anatomy showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia, by retracting the white line. Adipose layers were clearly observed in 195 out of 200 patients with bilateral mild ptosis, among which 180 cases had the superficial layer connected to the uncoated adipose. Fifteen cases had the superficial layer connected to the smoothly coated layer, and 5 cases had the superficial layer directly connected to the deep loose fiber, almost without adipose. In previously untreated patients, the LPSA space was located beneath the intact orbital septum. In those with previous surgeries, it was beneath the superficial layer of the LPSA, underlying the destructed orbital septum. Cadaveric histology showed that the deep layer of the LPSA extended into the anterior layer of the tarsal plate and the superficial layer reflexed upward in continuity with the vertical orbital septum. An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer. The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA. An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin. Recognition of the more anatomically significant LPSA deep layer may help improve the aesthetic outcome of blepharoplasty.

No MeSH data available.


Related in: MedlinePlus

Different types of connective tissues between the levator palpebrae superioris aponeurosis superficial and deep layers. (A) The anterior layer (AL) was connected to the uncoated adipose layer (180 out of 200 patients had this mode, 90%), (B) the AL was connected to the smoothly coated adipose layer (15 out of 200 patients had this mode, 7.5%), and (C) the AL was connected to the loose connective-fibrillary tissue (5 out of 200 patients had this mode, 2.5%).
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Figure 4: Different types of connective tissues between the levator palpebrae superioris aponeurosis superficial and deep layers. (A) The anterior layer (AL) was connected to the uncoated adipose layer (180 out of 200 patients had this mode, 90%), (B) the AL was connected to the smoothly coated adipose layer (15 out of 200 patients had this mode, 7.5%), and (C) the AL was connected to the loose connective-fibrillary tissue (5 out of 200 patients had this mode, 2.5%).

Mentions: In live patients, the vertical orbital septum fused with the LPSA into the white line with a variable thickness and located in proximity to the superior tarsal plate margin (Fig. 2C). Gross examination showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia by retracting the white line (Fig. 2D). Overlying the LPSA space was the superficial layer of the LPSA, and beneath the space was the deep layer covered by adipose or fibroconnective tissue. An intact orbital septum was located above the LPSA space in previously untreated patients (Fig. 2D), and a destructed orbital septum was identified above the superficial layer in previously treated patients (Fig. 3A–D). Among the 200 patients with mild bilateral ptosis, adipose layers were clearly observed in 195 cases, among which 180 cases (Fig. 4A) had the superficial layer connected to the uncoated adipose, while 15 cases (Fig. 4B) had the superficial layer connected to the smoothly coated layer. The other 5 patients had the superficial layer directly connected to the deep loose fiber, almost without adipose (Fig. 4C).


Aponeurosis of the levator palpebrae superioris in Chinese subjects: A live gross anatomy and cadaveric histological study.

Pan E, Nie YF, Wang ZJ, Peng LX, Wu YH, Li Q - Medicine (Baltimore) (2016)

Different types of connective tissues between the levator palpebrae superioris aponeurosis superficial and deep layers. (A) The anterior layer (AL) was connected to the uncoated adipose layer (180 out of 200 patients had this mode, 90%), (B) the AL was connected to the smoothly coated adipose layer (15 out of 200 patients had this mode, 7.5%), and (C) the AL was connected to the loose connective-fibrillary tissue (5 out of 200 patients had this mode, 2.5%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979838&req=5

Figure 4: Different types of connective tissues between the levator palpebrae superioris aponeurosis superficial and deep layers. (A) The anterior layer (AL) was connected to the uncoated adipose layer (180 out of 200 patients had this mode, 90%), (B) the AL was connected to the smoothly coated adipose layer (15 out of 200 patients had this mode, 7.5%), and (C) the AL was connected to the loose connective-fibrillary tissue (5 out of 200 patients had this mode, 2.5%).
Mentions: In live patients, the vertical orbital septum fused with the LPSA into the white line with a variable thickness and located in proximity to the superior tarsal plate margin (Fig. 2C). Gross examination showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia by retracting the white line (Fig. 2D). Overlying the LPSA space was the superficial layer of the LPSA, and beneath the space was the deep layer covered by adipose or fibroconnective tissue. An intact orbital septum was located above the LPSA space in previously untreated patients (Fig. 2D), and a destructed orbital septum was identified above the superficial layer in previously treated patients (Fig. 3A–D). Among the 200 patients with mild bilateral ptosis, adipose layers were clearly observed in 195 cases, among which 180 cases (Fig. 4A) had the superficial layer connected to the uncoated adipose, while 15 cases (Fig. 4B) had the superficial layer connected to the smoothly coated layer. The other 5 patients had the superficial layer directly connected to the deep loose fiber, almost without adipose (Fig. 4C).

Bottom Line: An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer.The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA.An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin.

View Article: PubMed Central - PubMed

Affiliation: aSouthern Medical University bDepartment of Plastic Surgery, Guangzhou General Hospital of Guangzhou Military Command of PLA cAesthetic Plastic Surgery, Hospital of the San Yet-Sun Medical University, Guangzhou dLOMEYE Medical Beauty Clinic, Beijing, China.

ABSTRACT
An accurate understanding of the anatomy of the levator palpebrae superioris aponeurosis (LPSA) is critical for successful blepharoplasty of aponeurotic ptosis. We investigated the macroscopic and microscopic anatomy of the LPSA.This prospective live gross anatomy study enrolled 200 adult Chinese patients with bilateral mild ptosis undergoing elective blepharoplasty. Full-thick eyelid tissues and sagittal sections from the eyelid skin to the conjunctiva were examined with Masson trichrome staining or antismooth muscle actin (SMA) immunohistochemistry.Gross anatomy showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia, by retracting the white line. Adipose layers were clearly observed in 195 out of 200 patients with bilateral mild ptosis, among which 180 cases had the superficial layer connected to the uncoated adipose. Fifteen cases had the superficial layer connected to the smoothly coated layer, and 5 cases had the superficial layer directly connected to the deep loose fiber, almost without adipose. In previously untreated patients, the LPSA space was located beneath the intact orbital septum. In those with previous surgeries, it was beneath the superficial layer of the LPSA, underlying the destructed orbital septum. Cadaveric histology showed that the deep layer of the LPSA extended into the anterior layer of the tarsal plate and the superficial layer reflexed upward in continuity with the vertical orbital septum. An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer. The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA. An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin. Recognition of the more anatomically significant LPSA deep layer may help improve the aesthetic outcome of blepharoplasty.

No MeSH data available.


Related in: MedlinePlus