Two fibromuscular transverse ligaments related to the levator palpebrae superioris: Whitnall's ligament and an intermuscular transverse ligament

Lukas, Julius; Priglinger, SG; Denk, Michaela; Mayr, Robert

doi:10.1002/(sici)1097-0185(199611)246:3<415::aid-ar13>3.3.co;2-o

Cited by 7 publications

(16 citation statements)

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“…Lukas et al demonstrated a high proportion of elastic fibres, 3 whereas Osanai et al found no elastic fibres in the ligament. 11 The ITL, on the other hand, consistently shows a high percentage of elastic fibres, 3,11 similar to other extraocular muscle pulleys. 12 Although Whitnall ligament and the ITL form the LPS muscle pulley, the paucity of elastic fibres in Whitnall ligament 3-5 is unique in comparison with their abundance in other extraocular muscle pulleys.…”

Section: Introductionmentioning

confidence: 97%

“…10 However, the actual amount of elastic fibres in this ligament is controversial. Lukas et al demonstrated a high proportion of elastic fibres, 3 whereas Osanai et al found no elastic fibres in the ligament. 11 The ITL, on the other hand, consistently shows a high percentage of elastic fibres, 3,11 similar to other extraocular muscle pulleys.…”

Section: Introductionmentioning

confidence: 98%

“…2 Eventually, it was shown to work as a pulley component of the LPS muscle, forming a sleeve structure with the intermuscular transverse ligament (ITL). [3][4][5] The ITL is the counterpart of Whitnall ligament. [3][4][5] It also originates from the trochlea and inserts into the lateral orbital wall on the deeper part of Whitnall ligament.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] The ITL is the counterpart of Whitnall ligament. [3][4][5] It also originates from the trochlea and inserts into the lateral orbital wall on the deeper part of Whitnall ligament. [3][4][5][6][7] Whitnall ligament crosses between the orbital and palpebral lobes of the lacrimal gland, whereas the ITL passes only behind the palpebral lobe.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] It also originates from the trochlea and inserts into the lateral orbital wall on the deeper part of Whitnall ligament. [3][4][5][6][7] Whitnall ligament crosses between the orbital and palpebral lobes of the lacrimal gland, whereas the ITL passes only behind the palpebral lobe. 6,7 Because the ITL is situated more posterior than Whitnall ligament, which is just under the culminating point of the LPS muscle, 4,8 the ITL affects the course of the LPS muscle.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Whitnall ligament anatomy revisited

Kakizaki¹,

Takahashi²,

Nakano³

et al. 2010

Clinical &Amp; Experimental Ophthalmology

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Whitnall ligament anatomy revisited

Kakizaki¹,

Takahashi²,

Nakano³

et al. 2010

Clinical &Amp; Experimental Ophthalmology

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Double reinsertion including Whitnall’s ligament in aponeurotic ptosis surgery

Pfeiffer

Reche-Sainz

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose The results of a technique with a double reinsertion of the aponeurosis to the tarsus and aponeurosis to Whitnall’s ligament (ATW) were compared with a simple reinsertion of the aponeurosis to the tarsus (AT) in acquired aponeurotic palpebral ptosis surgery. Methods Analytical, observational, retrospective, cohort study. Seven hundred and twenty-two consecutive cases with acquired aponeurotic palpebral ptosis have been treated surgically between 2000 and 2012 and have been followed up for 5 years. The cases were divided into two cohorts according to the applied surgical technique (AT vs ATW). Results The mean postoperative MRD after 1 month in cohort AT was 1 mm lower than in ATW (3 ± 0.9 mm vs 4 ± 1 mm). The mean MRD in the long-term follow-up (5 years) was 1 mm lower in cohort AT than in ATW (2.9 ± 1.5 mm vs 3.9 ± 0.9 mm). The rate of long-term recurrence (5 years) was 15% higher in A-T than in A-T-W (20% vs 5%). 70.5% of the eyes studied intra-surgically presented gaps between the Whitnall ligament and the aponeurosis, an anatomical area that we describe as the upper transition zone (UTZ). In an independent analysis, only those patients with open UTZ were evaluated and it was observed that those operated with A-T-W presented elevations greater than 1 mm compared to those operated with the AT technique (4 ± 0.9 mm A-T-W vs 2.8 ± 1 mm A-T) and a much lower recurrence rate (5.4% A-T vs 38.09% A-T-W). Conclusions In our study, the A-T-W technique achieved better results in terms of palpebral elevation and fewer recurrences compared to the A-T technique in all cases studied with aponeurotic ptosis. However, it particularly demonstrates its superiority in patients with large gaps in the UTZ.

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Double insertions of extraocular rectus muscles in humans and the pulley theory

et al. 2005

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Recent studies have promoted the concept that rectus muscles pass through connective tissue pulleys located near the equator of the eye and act, in effect, as the muscle origins. Orbital muscle fibres (facing bone) terminate in pulleys, permitting adjustment of their position independent of the global fibres responsible for rotating the eye.The structure of pulleys (or muscle sleeves) and the passage taken by their muscle fibre insertions are unclear, and a detailed description is presented here together with a review of the active pulley hypothesis. Segments including the full width of single muscles were removed from the full orbital contents of dissection room cadavers and fresh perfusion-fixed rhesus and cynomolgus monkeys and prepared for light microscopy. Thin longitudinal sections were cut as facets from resin-embedded tissue blocks and montages assembled. Interrupted serial sections of selected regions of both species and ultrathin sections of monkey material were prepared for light and electron microscopy, respectively. Slender tendons leave the orbital surface of rectus muscles at intervals, aggregating and entering sleeves in humans and monkey; less frequently, tendons pass from the global surface to sleeves or insert directly in the posterior fascia bulbi. The orbital sides of sleeve rings are continuous with the fascial canopy of the globe and are 5 -6 times as thick as the global sides; sleeve structure differs in the four recti. Medial rectus sleeves are the thickest, and contain smooth muscle, whereas little or none is present in the other rectus sleeves. Superior rectus sleeves are variable in structure and relatively insubstantial. A narrow interval separates muscles from the surrounding connective tissue equatorially in some preparations, consistent with a capacity to slide, but the tissues are contiguous in others, especially in monkey material. The structural organization of sleeves and their tendons, together with other presented factors, is inconsistent with a facility for the separate adjustment of sleeve position.The results favour the theory that sleeve tendons have just one role, to counter the viscoelastic resistance of global fascia -ocular and sleeve muscle fibres acting in unison. Whether the fragile sleeve structure can meet the physical demands of pulleys is questionable; but otherwise the veracity of the pulley hypothesis cannot be assessed from the structural relations of muscles and fascia bulbi reported.

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Two fibromuscular transverse ligaments related to the levator palpebrae superioris: Whitnall's ligament and an intermuscular transverse ligament

Cited by 7 publications

References 1 publication

Whitnall ligament anatomy revisited

Whitnall ligament anatomy revisited

Double reinsertion including Whitnall’s ligament in aponeurotic ptosis surgery

Double insertions of extraocular rectus muscles in humans and the pulley theory

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