What it means for a patient
- Puffy swellings on the upper cheek (malar mounds and festoons) have a lower edge set by a band of tissue that holds in fluid.
- Swelling of the lower lid may, over time, make these mounds more noticeable. The authors suggest this progression. The abstract reports no measured progression in patients.
- The same band also marks the lower edge of bruising around the eye.
- Surgery for malar mounds involves four layers of tissue.
- This is a cadaver study of 18 specimens. It does not report treatment results.
Why this paper matters
It described the malar septum and used it to explain where malar mounds, edema, festoons and bruising stop on the cheek. It set out the four compartments to consider in surgery for malar mounds.
Overview
The authors studied the anatomy behind malar mounds and malar edema in 18 fresh cadaver dissections. They used dye injection, histology and gross dissection. With these methods they identified a previously unrecognized fascial structure of the lower eyelid and cheek, which they call the malar septum.
Findings
- 18 fresh cadaver dissections.
- The malar septum starts at the periosteum of the orbital rim and inserts into the cheek skin 2.5 to 3 cm below the lateral canthus.
- It acts as a relatively impermeable barrier that allows swelling and hemoglobin pigment to collect above its insertion in the skin.
- It is both a functional and a structural barrier.
- It defines the lower border of malar mounds, malar edema, malar festoons and periorbital ecchymosis.
- In at least some people, chronic lower lid edema may make malar mounds more prominent.
- The septum's permeability may imply a progression over time from malar edema to malar mounds and then to malar festoons.
- It defines four compartments of the malar mound to consider in surgery: the superior compartment of suborbicularis oculi fat, the orbicularis oculi muscle, the superficial cheek fat, and the cheek skin above the septum's insertion.
Terms
- Malar: relating to the cheek.
- Malar mound: a soft swelling on the upper cheek below the lower lid.
- Malar festoon: a hanging fold of skin and tissue on the upper cheek.
- Malar edema: fluid swelling of the upper cheek.
- Septum: a sheet of tissue that separates two spaces.
- Fascia: a sheet of connective tissue.
- Periosteum: the thin layer that covers bone.
- Lateral canthus: the outer corner of the eye.
- Ecchymosis: bruising.
- Cadaver dissection: study of anatomy in a donated body.