眶肌筋膜韧带和眶肌支持韧带松解在下睑年轻化中的作用

Studies about the fascia ligament of orbicularis oculi and orbital retainning ligament and application to their release in lower blepharoplasty

目的 研究眶肌支持韧带与眶肌筋膜韧带（王韧带）解剖的异同，及对其松解在下眼睑年轻化手术中的作用。方法复习眶颧区韧带解剖的文献，与王氏韧带进行尸体解剖研究和组织学观察对比，并对501例王氏韧带松解和提紧下睑年轻化手术进行回顾和分析。结果王韧带是纤维结缔组织结构，位于下睑外侧眼轮匝肌的深层，连结下睑外侧眼轮匝肌和下外侧眶嵴缘的骨膜，韧带长（13．5±2．5）mm，宽（11．0±2．0）mm。眶肌支持韧带，是眼轮匝肌和整个眶缘骨膜联结的支持韧带。松解王韧带，可以多切除下睑松弛皮肤3～6mm或更多，相比于松解眶肌支持韧带手术，其具有操作容易、创伤小等优点。结论在下睑年轻化手术中，松解或提紧王韧带，使下睑眼轮匝肌、皮肤的张力平衡，手术创伤小，眶区年轻化的效果好，可维持较长时间的美容效果。

Objective To study the anatomical and functional difference between fascial ligament of orbicularis oeuli and orbicularis retaining ligament and to analyze the clinical effect of releasing them in lower blepharoplasty. Methods The anatomy of the fascial ligament of orbicularis oculi was investigated in eadaverie and histological studies. A review of 501 cases of lower blepharoplasty were performed with combination of release and lift of this ligament. And the literatures review about the orbicularis retaining ligament. Results The anatomy of the fascial ligament of orbieularis oecnli dissection showed a distinct fibro-strueture which connects the inferolateral orbicularis oculi to the periosteum of the inferolateral orbital rim, and extends towards superiormedially and inserts into the deep surface of the orbicularis oculi at the junction of the muscle＇s middle and lateral thirds. This ligament is （ 13.5±2.5） mm in length and （ 11.0 ±2.0） mm in width. Release of this ligament in lower blepharoplsty, 3 -6 mm more redundant skin in lower eyelid can be removed than the traditional blepharoplasty which can improve the outcome of periorbital rejuvenation and achieve better long-standing aesthetic results. To release the orbicularis retaining ligament is a more extensive procedure of lower blephroplasty. Conclusion The fascial ligament of orbieularis oeuli is a structure connecting the orbieularis oeuli to the periosteum of inferolateral orbital rim which limits free movement of orbiculais oculi. The lower blepharoplasty with combination of release and lift of this ligament can improve the outcome of lower blepharoplasty and achieve better long-standing aesthetic results.