Application Of Anatomical Features Of Pre-maxillary Space In The Transconjunctival Lower Blepharoplasty And Mid-facial Rejuvenation Surgery

Objective: 1.To study anatomical characteristics of the pre-maxillary space and surrounding structures,to clarify the position of the pre-maxillary space in relation to surrounding structures through dissecting fresh cadaver head.2.Using the anatomical features of the pre-maxillary space,a new surgical approach was designed to improve the efficacy of transconjunctival lower blepharoplasty and mid-face rejuvenation surgery.Material and Method: Anatomic part :10 sides of 5 antiseptic head specimens of the lower eyelids area were studied about observing the location and characteristics and relations of the pre-maxillary space,to measure related structures by vernier caliper and recording them through the text and 0image.There are three female and two male.With naked eye dissect the body of anatomical specimens,mark anatomical range with the marker pen.The dissection was from superficial span to deep span along the lower eyelids incision with the sophisticated orthopedic surgical instruments,stratified on the mid-face,observed,photographed.The anatomical location and relationship of pre-maxillary space and surrounding structure were observed.Clinical part:sixty cases of patients had obvious lower eyelids bag,tear trough deformity and some of the patients with slight skin laxity,including 40 females,20 males,24-55 years old,average 36 years old.All patients underwent "transconjunctival lower blepharoplasty and mid-facial rejuvenation surgery ”.Fifty-five patients were followed up for 1 to 1 year.The average follow-up time was 10.5 months.By comparing the improvement of the lower eyelids bag,tear deformity,and depression of the mid-face before and after the operation,the effect of its operation on blepharoplasty was observed.Results 1.Pre-maxillary space is located in front of the maxilla of the nasolabial segment of the middle cheek and accordingly named the pre-maxillary space.The structure is slightly rectangular,the superior boundary is the tear trough ligament,the inferior boundary is the maxillary ligament emitted by the periosteum and walking perpendicular to the dermis(the ligament is roughly at the level of the nasal base),the floor is the levator labii superioris,and the roof is the orbital part of the orbicularis oculi and part of SMAS layer.Medially,the pre-maxillaryspace is bounded by the lateral wall of the nose and the levator labii superioris alaeque nasi,and its lateral boundary is an area of the loose connective tissue at the medial of the pupil line.Similarly,the pre-maxillary space is an avascular plane lined by a membrane,which is easy to separate and has less damaged in operation.2.Supporting structure(1)Orbicularis retaining ligament,which originates from the infraorbital periosteum and travels between the palpebral and orbital orbicularis oculi and stops subcutaneously.This structure is a double-layered fascial tissue.The double-layer ligament continues inward at the medial of the pupil line and merges into a layer of tear trough ligament.The tear trough ligament forms the superior bound of the pre-maxillary space.(2)The maxillary ligament,which consist of 2-3 bundles of tendon dense connective tissue fibers,originates from the maxillary periosteum at the level of the nasal base and reaches the dermis vertically.Levator anguli oris is penetrated in the deep layer,and the zygomaticus is penetrated in the superficial layer.It penetrates the malar fat pad from deep to superficial layer,and ends at the skin.3.The levator labii superioris originates from the bone surface between infraorbital margin and the infraorbital foramen,and passed downward and inward through the dermis of the lateral nasolabial grooveof the upper lip.The muscle ends at the junction between the dermis of the uppermost of medial nasolabial groove and the lip red.The levator labii superioris forms the floor of the pre-maxillary space.4.Of the 60 patients,55(5 of whom were lost to follow-up)were followed up for an average of 10.5 months.Collect the patient’s face in an upright position and a 45 oblique position.Preoperative and postoperative lower eyelids bag,tear deformity,and depression of the mid-face were corrected,and no obvious complications such as obvious eyelid separation,eversion of lower eyelid,and postoperative bleeding were found.Transconjunctival lower blepharoplasty and mid-facial rejuvenation surgery is a more effective method to achieve young facial rejuvenation.Conclusion: 1.The pre-maxillary space is potential soft tissue space structure of the mid-face.The space provides a safe approach to the mid-face and atraumatic access for transconjunctival lower blepharoplasty and mid-facial rejuvenation,readily open up in submuscular lower eyelid blepharoplasties。 2.Transconjunctival lower blepharoplasty and mid-facial rejuvenation surgery is a simple and effective method for correcting the lower eyelids bag,accompanied by inferior orbital margin tear deformity,and slight skin laxity.