The Orbitomalar Ligament: A Cleavage Plane in Oculofacial Trauma.

Abstract

We describe an oculofacial injury phenotype manifesting as a cleavage plane following the orbitomalar ligament in 5 cases. Across these cases, curvilinear wounds followed the course of the orbitomalar ligament, running clean planes through orbicularis oculi down to the infraorbital rim and arcus marginalis. One case involved bilateral orbitomalar ligaments, and 1 case involved the inferior canaliculus. Associated craniofacial injuries included orbital floor fracture, orbital hemorrhage, and zygomaticomaxillary complex fractures. Moderate-to-severe globe injuries were encountered, including hyphema, commotio retinae, retinal hemorrhages, cyclodialysis cleft, lens dislocation, and globe rupture. Wound closure included deep polyglactin sutures to recreate mid-facial support from the disrupted orbitomalar ligament; 1 case that did not receive deep, layered closure was associated with lower eyelid ectropion. These cases illustrate how orbitofacial ligaments may influence trauma phenotypes and inform subsequent repair.