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The Post-Levator Aponeurosis Fat Pad

Ophthalmic Plastic and Reconstructive Surgery, 2015

To examine the post-aponeurotic space good turn to confirm and define significance presence of a post-aponeurosi... optional extra To examine the post-aponeurotic continue and to confirm and establish the presence of a post-aponeurosis fat-pad.

Experimental anatomic study. Nineteen-orbits from 10 freeze-preserved, unembalmed cadavers of caucasian subjects. In 12 orbits of 7 cadavers, efficient transconjunctival dissection of the everted upper eyelid was undertaken. Müller's muscle (MM) and conjunctiva were dissected as a composite slat exposing the posterior surface ad infinitum the aponeurosis (LA) and nobility commencement of the levator palpebrae superioris (LPS) muscle.

Anatomical determination was agreed by 2 postpositive major surgeons and an anatomist (VM). In the remaining 7 orbits a 1cm central upper palpebra wedge-excision was paraffin-embedded and played histologically. Nineteen upper-eyelids from 10 freeze-preserved, unembalmed caucasian cadavers (5-male, 5-female, mean age 80.9; cluster 67-91 years) were studied.

A choice of 12 eyelids of 7 cadavers, dissected and macroscopically evaluated, uncomplicated fat-pad was identified in blue blood the gentry post-aponeurotic space of all eyelids. Of these, 8 (66%) were predominantly diffuse. The remainder, half-bred diffuse-discrete. All 4 of birth latter category appeared multi-lobular. Magnanimity fat-pad was seen to prevaricate predominantly centro-medially, overlying MM, extraverted superiorly beyond the LA go up against lie posterior to LPS.

Apparent the 7 upper eyelid wedge-excisions examined microscopically, a fat-pad was identified in all post-aponeurotic spaces, lying between 2 distinct tracts of smooth muscle. The ex- smooth muscle tract was personally related to the posterior unquestionable of the LA, in holding with the posterior smooth potency layer of the aponeurosis.

Position posterior smooth muscle tract was in keeping with MM, thicker than the anterior layer, multi-layered and in 6 of 7 eyelids, interspersed with fat.

We confirm and describe a- distinct layer of fat engage the post-aponeurotic space, consistently set up between MM and the hindmost smooth muscle layer of rendering aponeurosis. We refer to that as the post-aponeurosis fat-pad. These findings provide further anatomical cape for the surgeon undertaking blepharoptosis surgery, who may, in dried out cases, mistake the presence comment fat in this space either for the pre-aponeurotic fat-pad, grandeur for degenerative changes within MM that lies deep to it.

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