衰老所致泪槽畸形和睑颊沟畸形发生机制的解剖学研究

Anatomic study on the mechanism of tear trough deformity and palpbromalar groove deformity

目的 研究衰老所致泪槽畸形及脸颊沟畸形解剖学方面的形成机制.方法 对6具60岁以上泪槽畸形及睑颊沟畸形较明显的尸体标本（男性3具,女性3具,平均年龄67.2岁）的下睑及眶周区域做逐层解剖（12侧）,观察眶部各层组织间的相互关系.结果 泪槽畸形及睑颊沟畸形处于眼睑较薄皮肤与颧颊部较厚皮肤的交界处,皮肤与眼轮匝肌附着较紧密;颧部脂肪上缘覆盖于眼轮匝肌睑部与眶部的结合部,并与泪槽及睑颊沟的位置相对应,颧部脂肪七缘不随颧脂肪垫下移;内侧眼轮匝肌眶部与提上唇鼻翼肌之间隙与泪槽位置不对应;眼轮匝肌限制韧带起于眶下缘并止于眼轮匝肌睑部与眶部的结合部,外宽内窄,在内侧1/3延续为内眦部深层眼轮匝肌,直接贴附于眶下缘骨面;眼轮匝肌下脂肪位于眶部外下方,薄且松弛;眶隔附着于眶下缘.眶脂肪向前下方膨出.结论 泪槽畸形和睑颊沟畸形形成是衰老所致各层组织松弛、萎缩和下移等综合因素共同作用的结果,其中眶隔及眼轮匝肌限制韧带限制组织下移的作用町能是眶下缘凹陷更加凸显的关键.

Objective To study the anatomic mechanism of tear trough deformity and palabromalar groove deformity. Methods Six cadavers（12 sides, 3 male, 3 female, an average age of 67.2 years） with tear trough deformity and palpbromalar groove deformity underwent lower eyelid and periorbital area dissection. Results Tear trough deformity and palabromalar groove deformity locate at the junction of thin eyelid skin and thick cheek skin. Skin is closely attached to the orbicularis oculi muscle. The superior border of the malar fat pad covers the junction of the palpebral and orbital portions of the orbicularis muscle, and does not desend with malar fat pad, which is also corresponded to the location of tear trough and palpbromalar groove. The gap between the orbicularis oculi muscle and the levator labii superioris alaeque nasi muscle is not correspond to tear trough. The orbicularis retaining ligament arises from the orbital rim and ends at the junction of the palpebral and orbital portions of the orbicularis muscle, and the ligament connects with the deep part of the orbicularis muscle which directly attachs to the infraorbital rim. Suborbicular oculi fat pads locate at the inferolateral of the orbital region, thin and flabby. Orbital septal arises from the infraorbital rim, and the orbital fat extrudes anteriorly and inferiorly. Conclusions Tear trough deformity and palabromalar groove deformity are resulted from combination of age-related relaxation, atrophy and ptosis of layers of tissues . The orbital septal and the orbicularis retaining ligament prevent tissues from descending, which makes tear trough deformity and palabromalar groove deformity more visible.