Whitnall ligament anatomy revisited

Purpose: To examine the concentrations of elastic fibres in Whitnall ligament and the intermuscular transverse ligament (ITL), and to examine the anatomic relationships between Whitnall ligament and its surrounding structures. Design: Observational anatomic study. Samples: Full thickness sagittal sections of 12 upper eyelids (6 right and 6 left), fixed in 10 % buffered formalin, were studied in 10 Asian cadavers (mean age at death: 77.1 years, range: 62-92 years). Methods: We analysed the concentrations of elastic fibres in Whitnall ligament and the ITL, as well as examined the relationship between Whitnall ligament and the connective tissue septa, the ITL and the levator palpebrae superioris (LPS) muscle. Main Outcome Measures: Concentrations of elastic fibres in Whitnall ligament and the ITL, relationship between Whitnall ligament and its surrounding structures. Results: The concentration of elastic fibres in Whitnall ligament was low compared to the ITL. In most specimens, both Whitnall ligament and the ITL were loosely attached to the LPS muscle through areas of adipose tissue or cavities. Although in all specimens, connective tissue septa were demonstrated next to Whitnall ligament, they were more often directed parallel to the ligament rather than radially to it. Conclusion: Both Whitnall ligament, with its low concentration of elastic fibres, and the ITL, with its high content of elastic fibres, show loose attachments to the LPS muscle through areas of adipose tissue or cavities. Whitnall ligament may work as the check ligament of the LPS muscle as well as part of the pulley system with the ITL.