The medial palpebral ligament (medial canthal tendon) is a

ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal li ...

of the

face The face is the front of an animal's head that features the eyes, nose and mouth, and through which animals express many of their emotions. The face is crucial for human identity, and damage such as scarring or developmental deformities may aff ...

. It attaches to the frontal process of the

maxilla The maxilla (plural: ''maxillae'' ) in vertebrates is the upper fixed (not fixed in Neopterygii) bone of the jaw formed from the fusion of two maxillary bones. In humans, the upper jaw includes the hard palate in the front of the mouth. The t ...

, the

lacrimal groove On the nasal surface of the body of the maxilla, in front of the opening of the sinus is a deep groove, the lacrimal groove (or lacrimal sulcus), which is converted into the nasolacrimal canal, by the lacrimal bone and inferior nasal concha; this ...

, and the tarsus of each

eyelid An eyelid is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. The human eyel ...

. It has a superficial (anterior) and a deep (posterior) layer, with many surrounding attachments. It connects the medial canthus of each eyelid to the medial part of the

orbit In celestial mechanics, an orbit is the curved trajectory of an object such as the trajectory of a planet around a star, or of a natural satellite around a planet, or of an artificial satellite around an object or position in space such as a p ...

. It is a useful point of fixation during eyelid

reconstructive surgery Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition. Description Reconstructive surgery is a term with training, clinical, and reimbursement implica ...

Structure

The anterior attachment of the medial palpebral ligament is to the frontal process of the

in front of the

(near the

nasal bone The nasal bones are two small oblong bones, varying in size and form in different individuals; they are placed side by side at the middle and upper part of the face and by their junction, form the bridge of the upper one third of the nose. Eac ...

and the

frontal bone The frontal bone is a bone in the human skull. The bone consists of two portions.''Gray's Anatomy'' (1918) These are the vertically oriented squamous part, and the horizontally oriented orbital part, making up the bony part of the forehead, par ...

), and its posterior attachment is the

lacrimal bone The lacrimal bone is a small and fragile bone of the facial skeleton; it is roughly the size of the little fingernail. It is situated at the front part of the medial wall of the orbit. It has two surfaces and four borders. Several bony landmarks of ...

. Crossing the

lacrimal sac The lacrimal sac or lachrymal sac is the upper dilated end of the nasolacrimal duct, and is lodged in a deep groove formed by the lacrimal bone and frontal process of the maxilla. It connects the lacrimal canaliculi, which drain tears from the ey ...

, it divides into two parts, upper and lower, each attached to the medial end of the corresponding tarsus of each

. As the ligament crosses the lacrimal sac, a strong

aponeurotic An aponeurosis (; plural: ''aponeuroses'') is a type or a variant of the deep fascia, in the form of a sheet of pearly-white fibrous tissue that attaches sheet-like muscles needing a wide area of attachment. Their primary function is to join musc ...

lamina Lamina may refer to: Science and technology * Planar lamina, a two-dimensional planar closed surface with mass and density, in mathematics * Laminar flow, (or streamline flow) occurs when a fluid flows in parallel layers, with no disruption betwee ...

is given off from its posterior surface; this expands over the sac, and is attached to the

posterior lacrimal crest The posterior lacrimal crest is a vertical bony ridge on the orbital surface of the lacrimal bone. It divides the bone into two parts. It gives origin to the lacrimal part of the orbicularis oculi muscle. Structure The posterior lacrimal crest ...

. The medial palpebral ligament consists of a superficial (anterior) and a deep (posterior) layer. The superficial layer has a length of around 9.6 mm, a width of around 2.4 mm, and a thickness of around 4.5 mm. The deep layer has a length of around 3.7, a width of around 2.9, and a thickness of around 0.3 mm. Together, these have a strength of around 17

newtons The newton (symbol: N) is the unit of force in the International System of Units (SI). It is defined as 1 kg⋅m/s, the force which gives a mass of 1 kilogram an acceleration of 1 metre per second per second. It is named after Isaac Newton in r ...

, with most of this strength from the superficial layer.

Relations

The superior branch of the

medial palpebral artery The medial palpebral arteries (internal palpebral arteries) are arteries of the head that contribute arterial blood supply to the eyelids. They are derived from the ophthalmic artery; a single medial palpebral artery issues from the ophthalmic arte ...

runs directly behind the medial palpebral ligament. Branches of the

facial nerve The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of tas ...

, particularly the

buccal branches The buccal branches of the facial nerve (infraorbital branches), are of larger size than the rest of the branches, pass horizontally forward to be distributed below the orbit and around the mouth. Branches The ''superficial branches'' run beneath ...

, pass upwards over the medial palpebral ligament to reach the

nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...

Function

The medial palpebral ligament connects the medial canthus of each eyelid to the medial part of the

Clinical significance

The medial palpebral ligament can be used as a point of fixation during

, allowing for normal

blinking Blinking is a bodily function; it is a semi-autonomic rapid closing of the eyelid. A single blink is determined by the forceful closing of the eyelid or inactivation of the levator palpebrae superioris and the activation of the palpebral portio ...

History

The medial palpebral ligament has also been known as the medial canthal tendon. Some consider it to be a

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

of the lacrimal part of the

orbicularis oculi muscle The orbicularis oculi is a muscle in the face that closes the eyelids. It arises from the nasal part of the frontal bone, from the frontal process of the maxilla in front of the lacrimal groove, and from the anterior surface and borders of a short ...

References