Anatomy of arcuate expansion of capsulopalpebral fascia.

The aim of this study was to elucidate the detailed anatomic structure of arcuate expansion (AE) and its nearby structures. Eighteen orbits of 13 Korean adult male cadavers of a mean age of 76.5 years (range, 75-78 years) were used. Sixteen specimens were grossly dissected, and 2 were for histologic study.Arcuate expansion is a fibrous band expanding from the inferolateral orbital rim to the medial canthal ligament. A sector (fan shaped) of AE originated in the angle of 5 to 80 degrees at the circumference of the inferolateral orbital rim circle, falling within the range of 3 to 5.5 o'clock, and tapered and attached to the inferior border of the medial canthal ligament. Arcuate expansion was located deep to the orbital septum and superficial to the inferior oblique (IO) muscle. It overlapped the middle part of the IO muscle as it crossed and connected to the capsulopalpebral fascia. The tensile strength of the 5-mm width of AE at halfway was 6.7 +/- 3.8 N, and that at the orbital margin was 5.4 +/- 2.7 N.We think that AE prevents the protrusion of the eyeball and orbital fat and functions as a pulley holding overcontraction of the IO muscle.

Bleeding from posterior superior alveolar artery in Le Fort I fracture.

This article describes a patient in whom significant oronasal bleeding developed after an injury to posterior superior alveolar artery of the maxillary artery in Le Fort I fracture.A 34-year-old man had a facial injury after an explosion of a furnace. Computed tomography demonstrated Le Fort I fracture, right open zygomatic tripod fracture, and open nasal bone fracture. Blood pressure, hemoglobin, and hematocrit levels had fallen to 110/60 mm Hg, 5.7 mg/dL, and 16.1%, respectively, 10 hours after injury despite continuous blood transfusion. Selective digital angiography confirmed an injury to the posterior superior alveolar artery, with extravasated pooling of contrast material in the maxillary sinus. The distal internal maxillary artery was embolized with n-butyl cyanoacrylate and lipiodol. Postembolization angiogram showed resolution of the contrast leak, and the patient's oronasal bleeding resolved.We suggest that if the oronasal bleeding continues in Le Fort fracture, bleeding from the posterior superior alveolar artery should be suspected. In case the vital sign is not stable, selective angiography should be performed before surgery.