General Principles for Approaches to the Facial Skeleton - part 4

Cách tiếp cận mí mắt trên vành quỹ đạo superolateral còn được gọi là blepharoplasty trên, nếp gấp mí mắt trên, và cách tiếp cận lần supratarsal. Trong phương pháp này, một nhăn da tự nhiên trong mí mắt trên được sử dụng để làm cho vết rạch. Ưu điểm của phương pháp này là vết sẹo không dễ | Step 4. Subperiosteal Dissection of Lateral Orbital Rim and Lateral Orbit Two sharp periosteal elevators are used to expose the lateral orbital rim on the lateral medial intraorbital and if necessary posterior temporal surfaces Fig. 4-2 . Wide undermining of the skin and periosteum allows the tissues to be retracted inferiorly providing better access to the lower portions of the lateral orbital rim. If one stays in the subperiosteal space there is virtually no chance of damaging structures. Step 5. Closure The incision is closed in two layers the periosteum and the skin. 54 5 Upper Eyelid Approach The upper eyelid approach to the superolateral orbital rim is also called upper blepharoplasty upper eyelid crease and supratarsal fold approach. In this approach a natural skin crease in the upper eyelid is used to make the incision. The advantage of this approach is the inconspicuous scar it creates which makes it one of the best approaches to the region of the superolateral orbital complex. SURGICAL ANATOMY Upper Eyelid In sagital section the upper eyelid consists of at least five distinct layers the skin the orbicularis oculi muscle the orbital septum above or levator palpebrae superioris aponeurosis below Muller s muscle tarsus complex and the conjunctiva Fig. 5-1 . The skin orbicularis oculi muscle and conjunctiva of the upper eyelid are similar to those of the lower eyelid see previous text . The upper eyelid differs from the lower eyelid however by the presence of the levator palpebral superioris aponeurosis and Muller s muscle. Orbital Septum Levator Aponeurosis Complex. Deep to the orbicularis oculi muscle lies the orbital septum levator aponeurosis complex. Unlike the situation in the lower eyelid where the orbital septum inserts into the tarsal plate in the upper eyelid the orbital septum extends inferiorly and blends with the levator aponeurosis approximately 10 to 15 mm above the upper eyelid margin. The levator muscle usually becomes aponeurotic at the .