Evaluation of the anatomical position of the lateral canthal ligament: clinical implications and guidelines

Controversy exists in the literature as to the precise anatomical location of the lateral canthal ligament. The ligament is a 3 mm-wide, two-tailed band; its average length is approximately 13 mm, while the width of the rima palpebralis is about 26 mm. The authors evaluated three different groups to pinpoint the anatomical position of the ligament's attachment to the lateral orbital wall, and to establish guidelines for placement of the ligament during surgery. In 90% of the cases, the ligament was attached to Whitnall's tubercle, which is located approximately 4 mm posterior to the lateral orbital rim, and 17 mm above the intersection of the lateral and inferior margins; this area is 9 mm below the zygomaticofrontal suture. Based on these anatomical criteria, a standardized procedure is suggested.