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Studies on the muscular-deep fascial system which connects the upper eyelid, brow, and glabella, are lacking. This study aimed to explore the fine anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin. We included eight formalin-phenol-embalmed cadavers (16 sides of specimens), and categorized them into anatomical dissections and histological sections. Five cadavers (10 sides) were dissected for gross anatomical observation, whereas all soft tissues of the other three cadavers (6 sides) were dissected for tissue sectioning and histological analysis. Three tissue blocks and 16 strips in each block were trimmed, numbered, and sliced into these specimens. Hematoxylin-Eosin and Masson's Trichrome staining were performed. In the region between the eyebrow and the superior orbital margin, the frontalis was covered by the orbicularis oculi. Fibers of the frontalis muscle penetrated into the orbicularis oculi muscle bundles, and crosslinked around the eyebrow level. Both the frontalis and the orbicularis oculi were attached to the thickened multilayered deep fascia in this region, which could be regarded as the muscular-deep fascial system. The muscular-deep fascial system connects the frontalis deep fascia and deep forehead compartments down to the orbicularis-supporting ligament. The precise anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin may provide a valuable reference for soft-tissue fixation and suspension in facial surgery.

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BACKGROUND: Orbital volume refers to the sum of bulbus oculi volume and orbital cavity volume. Scientists use orbital volume as a guide to diagnose, treat and prognose various eye diseases such as thyroid eye disease and enophthalmos. OBJECTIVE: This study aims to examine the orbital volumes of sheep, goats and gazelles to demonstrate homotypic variations and interspecific differences between them. METHODS: Crania of six male tuj sheep, five male hair goats and five male gazelle were used in this study. The crania were scanned using a 64-detector multi-detector computed tomography with a slice thickness of 0.625 mm at 80 kV, 200 MA and 639 mGy. The cross-sectional images were stored in DICOM format and then transferred to MIMICS 20.1 software. Afterwards, models were made by establishing the orbital borders on the cross-sections. Volume values were calculated based on the models. RESULTS AND CONCLUSION: No homotypic variation was found between the right and left volumes within the species (p > 0.05). A statistically significant difference was observed in terms of interspecific right and left orbital volumes between sheep and gazelles (p < 0.05). It was concluded that the orbital parameters of the sheep, goats and gazelles in the same family help reveal their differences in the visual anatomy of these species and provide reference data for clinical diagnosis, treatment and the prognosis follow-up of ocular diseases in animals.

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SUMMARY: Since machine learning algorithms give more reliable results, they have been used in the field of health in recent years. The orbital variables give very successful results in classifying sex correctly. This research has focused on sex determination using certain variables obtained from the orbital images of the computerized tomography (CT) by using machine learning algorithms (ML). In this study 12 variables determined on 600 orbital images of 300 individuals (150 men and 150 women) were tested with different ML. Decision tree (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), and Naive Bayes (NB) algorithms of ML were used for unsupervised learning. Statistical analyses of the variables were conducted with Minitab® 21.2 (64-bit) program. ACC rate of NB, DT, KNN, and LR algorithms was found as % 83 while the ACC rate of LDA and RFC algorithms was determined as % 85. According to Shap analysis, the variable with the highest degree of effect was found as BOW. The study has determined the sex with high accuracy at the ratios of 0.83 and 0.85 through using the variables of the orbital CT images, and the related morphometric data of the population under question was acquired, emphasizing the racial variation.

Dado que los algoritmos de aprendizaje automático dan resultados más fiables, en los últimos años han sido utilizados en el campo de la salud. Las variables orbitales dan resultados muy exitosos a la hora de clasificar correctamente el sexo. Esta investigación se ha centrado en la determinación del sexo utilizando determinadas variables obtenidas a partir de las imágenes orbitales de la tomografía computarizada (TC) mediante el uso de algoritmos de aprendizaje automático (AA). En este estudio se probaron 12 variables determinadas en 600 imágenes orbitales de 300 individuos (150 hombres y 150 mujeres) con diferentes AA. Se utilizaron algoritmos de AA de árbol de decisión (DT), K-Nearest Neighbour, regresión logística (RL), Random Forest (RF), análisis discriminante lineal (ADL) y Naive Bayes (NB) para el aprendizaje no supervisado. Los análisis estadísticos de las variables se realizaron con el programa Minitab® 21.2 (64 bits). La tasa de ACC de los algoritmos NB, DT, KNN y RL se encontró en % 83, mientras que la tasa de ACC de los algoritmos ADL y RFC se determinó en % 85. Según el análisis de Sharp, la variable con el mayor grado de efecto se encontró como BOW. El estudio determinó el sexo con alta precisión en las proporciones de 0,83 y 0,85 mediante el uso de las variables de las imágenes de TC orbitales, y se adquirieron los datos morfométricos relacionados de la población en cuestión, enfatizando la variación racial.

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OBJECTIVES: The red panda is currently the only surviving member of the Ailuridae family in the Caniformia suborder. In this study, we provide data on anatomical, morphometric, histological and histochemical examination of the orbital region, eyelids, orbital gland, and eye tunics in two adult males Ailurus fulgens fulgens from the Wroclaw Zoological Garden, Poland. METHODS: The study involved morphometric analysis of the eyeball and selected accessory organs of the eye, along with analysis of the bony orbit, including its morphometry, macroscopic, and microscopic evaluation. Microscopic evaluation encompassed histological and histochemical staining, with the former involving hematoxylin & eosin (H&E), Movat pentachrome, picro-Mallory trichrome, Fontana-Masson, and the latter including PAS, AB pH 1.0, AB pH 2.5; AB pH 2.5/PAS, and HDI. RESULTS: The upper (UE) and lower (LE) eyelids presented well-developed tarsal glands, sebaceous glands, and a characteristic simple alveolar gland (producing a mucous secretion). The palpebral part of the lacrimal gland was present. A single lymphoid follicle was observed only in the upper eyelids. The superficial gland of the third eyelid (SGTE) was a multilobar acinar complex that produces mucous secretion and is contained within the interlobular ducts of numerous aggregates of lymph nodes. The third eyelid (TE) was T-shaped and composed of hyaline tissue, containing CALT. The lacrimal gland (LG) also revealed a multilobar acinar complex that produced mucous secretion, with a single lymphoid follicle. The cornea consisted of 4 layers, as Bowman's membrane was absent. The Vogt palisades composed of 7-10 layers of epithelial cells were demonstrated. The pupil was horizontally ovoid at rest (post-mortem). The sphincter pupil and the dilator pupil were well developed. Macroscopically, the tapetum lucidum appeared as a milky, non-opalescent crescent. Histologically, the choroidal tapetum lucidum cellulosum consisted of 5 to 9 layers of loosely packed oval cells. The retina showed a composition similar to that of terrestrial nocturnal carnivores. CONCLUSIONS: The results of our research indicate that the anatomical features of the eye and orbital region in the red panda share similarities with those described in the Musteloidea clade, as well as the Canidae and Ursidae families.

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The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption. Subsequently, a comprehensive exploration of the anatomic bone pillars and intracranial spaces accessible via this approach is provided. Hence, five bone pillars of the transorbital approach were identified, namely the lesser sphenoid wing, the anterior clinoid, the sagittal crest, the middle cranial fossa, and the petrous apex. A detailed correlation of those bone targets with respective intracranial areas has been reported.Furthermore, the chapter delves into the practical application of the technique through a case example, offering insights into its clinical utility, indications, and limitations.

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Orbital fat is an adipose tissue located behind orbital septum and originates from mesoderm and neural crest in ectoderm. It has been found that the histologic structure of orbital fat is different from subcutaneous and visceral fat. In addition, the regeneration and anti-inflammatory ability of stem cells derived from orbital fat have attracted much attention in recent years. This paper reviews the recent research progress on orbital fat, including its structure, origin, histological characteristics, and related stem cells.

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PURPOSE: The past two decades have witnessed the rise of keyhole microscopic minimally invasive surgeries, including the transciliary supraorbital approach (TCA) and transpalpebral approach (TPA), commonly known as the transorbital approach. This study aims to elucidate the nuances, specific indications, and advantages of each approach. METHODS: A series of dissections were conducted on five formalin-fixed, alcohol-preserved cadaver heads. The TCA was performed on one side, and the TPA on the other. Virtual measurements of working angles for both approaches were recorded. Additionally, three clinical cases were presented to illustrate the practical application of the techniques. RESULTS: For TCA, the craniotomy dimensions were 1.7 cm x 2.5 cm (Cranial-Caudal (CC) x Lateral-Lateral (LL)), while for TPA, they measured 2.1 cm x 2.9 cm (CC x LL). The measurements of anterior clinoid processes (ACP) were obtained and compared between approaches. In the TCA, the mean ipsilateral ACP measurement was 62 mm (Range: 61 -63 mm), and the mean contralateral ACP measurement was 71.2 mm (Range: 70 -72 mm). In TPA, these measurements were 47.8 mm (Range: 47 -49 mm) and 62.8 mm (Range: 62 -64 mm), respectively. TCA exhibited an average cranial-caudal angle of 14.9°, while TPA demonstrated an average of 8.3°. CONCLUSION: The anterior cranial fossa was better exposed by a TCA, which also featured shorter operative times, enhanced midline visualization, and a quicker learning curve. Conversely, the middle fossa was better exposed by a TPA, making it an excellent option for middle fossa pathologies, including those in the anterior temporal lobe. After sphenoid bone wing drilling, the TPA offers superior visualization from the lateral to the medial aspect and enhances the CC angle. Additionally, the TPA reduces the risk of postoperative frontalis palsy based on anatomic landmarks. However, the TPA requires a greater cranial osteotomy, and due to unfamiliarity with eyelid anatomy, the learning curve for most neurosurgeons is lengthier for this procedure.

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We analysed the skulls and faces of Korean subjects using anthropometric methods to understand the anatomical characteristics of the eyeball and eye orbit region of Korean population and to determine the correlations between the hard and soft tissues around the eyeball and eye orbit region. In total, 82 sections in the region were measured to determine the correlations; among them, 34 showed significant differences by sex, and 6 showed significant differences by age. As the distance from the centre of the eye lens to the eye orbit is calculated as a ratio, we determined that the centre of the eye lens is located relatively on the lateral and superior position in each eye orbit in front view. Fourteen sections that could be used for craniofacial reconstruction/approximation in men and women were selected. Regression equations were derived according to the correlation of each section, and their reliabilities were verified by out of sample validation tests. Therefore, our results increase the accuracy of eyeball position determination, which would be useful for more efficient craniofacial reconstruction/approximation of the Korean population and should improve the efficiency of facial recognition.

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the aim of this paper, is to propose a new reference line: the Frontozygomatic-Infraorbital Line (FZ-IOL). This reference line can guide the surgical team planning mandibular angle harmonization, based on the patient's skeletal proportion. The Frontozygomatic-Infraorbital Line has been adopted for symmetrization surgery, masculinization surgery, and in unsatisfactory results of previous orthognathic surgery. From March 2021 to December 2022, 3 patients were treated for severe facial asymmetry affecting mainly the lower third of the face. All cases were planned with the reference FZ-IOL. Patients were treated in the same center, at the Orthognathic Surgery Department of the Instituto Portugues da Face, Lisbon, Portugal. The Frontozygomatic-Infraorbital Line is designed virtually using software to reconstruct a 3D image from a digital imaging and communications in medicine (DICOM) file obtained from a cone beam computer tomography (CBCT). , connecting the two orbital rims. Then, a vertical line, the frontozygomatic line perpendicular to the IOL and passing through the outmost lateral portion of the frontozygomatic suture is drawn. The proposed line demonstrated how establishing appropriate reference lines is crucial for the success of the surgery. The selection of reference lines should be based on the patient's anatomy, the symmetrization process's complexity, and the surgery's desired outcome. The Frontozygomatic-Infraorbital Line represents an adequate reference line for managing mandibular angle lateral projection, improving lower third of the face symmetrization.

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PURPOSE: To assist in surgical planning in endoscopic approaches, we analyzed the morphometric measurements of the superior orbital fissure (SOF) and optic canal (OC) by three-dimensional multislice computed tomography (3D MDCT) and evaluated them according to age, gender, and lateralization. METHODS: The study analyzed 219 MDCT images (114 women, 105 men) from individuals aged 18-90. Measurements of SOF and OC were performed on 3D MDCT images in the axial plane and with 3D-Slicer software. RESULTS: The distance between the infraorbital foramen and the anterior entrance of the maxillary sinus (CBW) (p < 0.001), the distance between the CBW and the lateral point of the SOF (p = 0.001), and the Angle 1 (p = 0.028) were higher in women than in men. While the SOF length and on 3D the SOF width were higher in women than men (p < 0.001 and (p = 0.001, respectively), the lateral wall length OC was higher in men than women (p = 0.045). According to SOF classification, SOF length was highest in type II and lowest in type VIII (p = 0.025), SOF width was highest in type I and lowest in type VI (p < 0.001). No significant difference was found based on age groups and lateralization in all parameters. CONCLUSION: We found that as the SOF width increased, the SOF length also increased, and there was a statistically strong positive correlation. These findings can contribute to a more effective and safe operation by improving and updating surgeons' knowledge about safe distances to SOF in endoscopic procedures from a 3D MDCT perspective.

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The transconjunctival approach, first described by Bourqet in 1923, has become a routine procedure for the management of fractures of the orbital floor, medial and lateral walls, and infraorbital rim. It is also used in aesthetic surgery and access surgery. Different approaches of transconjunctival surgery, however, can be complicated by the complex lower lid anatomy. In this publication we revisit the anatomy of the transconjunctival approach, and discuss the surgical steps for preseptal and postseptal dissection. We introduce the concept of interseptal space (potential space), its anatomy first described in 1991.

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PURPOS: The location of infraorbital foramen (IOF) and the prevalence of accessory IOF vary among different populations. It may lead to infraorbital nerve (ION) blockage during surgery. This study aimed to assess the IOF location and AIOF frequency in Iranian people. METHOD: In this retrospective cross-sectional study, 500 paranasal sinus computed tomography scans of adults were examined using the INFINITT PACS system. RESULT: The distance from IOF to infraorbital margin (IOM), mid-pupillary line (MPL), midsagittal line (MSL), canine eminence (CE), and skin thickness (ST) was 8.97 ± 1.79, 5.73 ± 1.84, 24.86 ± 2.23, 20.39 ± 3.47, and 10.90 ± 2.59 mm, respectively. The vertical and transverse diameters of the foramen were 3.03 ± 0.65 and 3.71 ± 0.76 mm, respectively. In addition, the shape of 63.5% of the foramina was oval. The prevalence of AIOF was 9%, and its most common location was superomedial to IOF. CONCLUSION: We believe that in this study, landmarks like IOM, MPL, MSL, CE and ST could help the clinicians localize IOF and improve the ION anesthesia success rate. Furthermore, the occurrence of AIOF should be considered by physicians to reduce the chance of injuries to the infraorbital neurovascular complex.

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BACKGROUND: Recent literature highlights anomalous cranial nerves in the sinonasal region, notably in the sphenoid and maxillary sinuses, linked to anatomical factors. However, data on the suspended infraorbital canal (IOC) variant is scarce in cross-sectional imaging. Anatomical variations in the sphenoid sinuses, including optic, maxillary, and vidian nerves, raise interest among specialists involved in advanced sinonasal procedures. The infraorbital nerve's (ION) course along the orbital floor and its abnormal positioning within the orbital and maxillary sinus region pose risks of iatrogenic complications. A comprehensive radiological assessment is crucial before sinonasal surgeries. Cone-beam computed tomography (CBCT) is preferred for its spatial resolution and reduced radiation exposure. OBJECTIVE: The aim of this study was to describe the prevalence of anatomical variants of the infraorbital canal (IOC) and report its association with clinical condition or surgical implication. METHODS: We searched Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to June 2023. Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. RESULTS: Preliminary results show that three types are prevalent, type 1: the IOC does not bulge into the maxillary sinus (MS); therefore, the infraorbital foramen through the anterior wall of MS could be used for identification of the ION. Type 2: the IOC divided the orbital floor into medial and lateral aspects. Type 3: the IOC hangs in the MS and the entire orbital floor lying above the IOC. From which the clinical implications where mainly surgical, in type 1 the infraorbital foramen through the anterior wall of MS could be used for identification of the ION, while in type 2, since the lateral orbital floor could not be directly accessed an inferiorly transposition of ION is helpful to expose the lateral orbital wall directly with a 0 scope; or using angled endoscopes and instruments, however, the authors opinion is that direct exposure potentially facilitates the visualization and management in complex situations such as residual or recurrent mass, foreign body, and fracture located at the lateral aspect of the canal. Lastly, in type 3, the ION it's easily exposed with a 0° scope. CONCLUSIONS: This systematic review identified four IOC variants: Type 1, within or below the MS roof; Type 2, partially protruding into the sinus; Type 3, fully protruding into the sinus or suspended from the roof; and Type 4, in the orbital floor. Clinical recommendations aim to prevent nerve injuries and enhance preoperative assessments. However, the lack of consistent statistical methods limits robust associations between IOC variants and clinical outcomes. Data heterogeneity and the absence of standardized reporting impede meta-analysis. Future research should prioritize detailed reporting, objective measurements, and statistical approaches for a comprehensive understanding of IOC variants and their clinical implications. Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/UGYFZ .

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PURPOSE: Awareness of normative values of extra orbital structures would provide useful information to interpret the radiological images better and use them for diagnostic purposes. This study aimed to reveal the average values of major extraocular structures measured on magnetic resonance images. METHODS: In this retrospective cross-sectional study, magnetic resonance (MR) images of 256 orbits of 128 patients were re-interpreted regarding the measurements of major orbital structures. Extraocular muscles, superior ophthalmic vein, and optic nerve-sheath complex were measured on orbital MR images of these patients. The data distributions were presented by box-plot analyses for each parameter, and the measurement results were analyzed regarding gender and age groups. RESULTS: Lateral rectus muscle thickness (LR), inferior rectus muscle thickness (IR), globe position (GP), and interzygomatic line (IZL) values were higher in the male group than in the female group (p values were < 0.001, 0.003, 0.020, and < 0.001 respectively). LR, the thickness of the superior group muscles (SUP GR), IR, superior oblique muscle thickness (SOBL), and the thickness of optic nerve-sheath complex (ON) values indicated a significant relationship between age groups. There was a significant, positive, and low-level correlation between age and LR, SUP GR, and IR values (p values were < 0.001, 0.001, and < 0.001, respectively). CONCLUSION: This study provides quantitative data on normative values of orbital structures with gender and age group comparisons. Clinicians or surgeons can easily use the measured values to gather diagnostic information from the orbital region.

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PURPOSE: This research aims to enhance understanding of the anatomy of the supraorbital nerve (SON) and greater occipital nerve (GON), focusing on their exit points, distal trajectories, and variability, utilizing a novel 3D representation. METHODS: Ten cadaveric specimens underwent meticulous dissection, and 3D landmarks were registered. Models were generated from CT scans, and a custom 3D method was employed to visualize nerve trajectories. Measurements, including lengths and distances, were obtained for the SON and GON. RESULTS: The SON exhibited varied exit points, with the lateral branches being the longest. The GON showed distinct branching patterns, which are described relative to various anatomical reference points and planes. No systematic left-right differences were observed for either nerve. 3D analysis revealed significant interindividual variability in nerve trajectories. The closest approximation between the SON and GON occurred between lateral branches. CONCLUSION: The study introduces a novel 3D methodology for analyzing the SON and GON, highlighting considerable anatomical variation. Understanding this variability is crucial for clinical applications and tools targeting the skull innervation. The findings serve as a valuable reference for future research, emphasizing the necessity for personalized approaches in innervation-related interventions.

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BACKGROUND: The fronto-temporo-orbito-zygomatic (FTOZ) craniotomy is a commonly utilized surgical approach for many complex skull base lesions, especially lesions traversing skull base compartments. This craniotomy has evolved over multiple stages, originating from the classic pterional craniotomy and many variations that have emerged over time. METHODS: Few clinical and anatomic studies have both shaped these craniotomies as well as provided immense information about instances in which they are most useful. We review the origin and history of the one-piece and two-piece fronto-temporo-orbito-zygomatic craniotomy and deliberate their advantages and disadvantages. RESULTS: The FTOZ craniotomy provides access to the orbit as well as to multiple compartments in the cranium (anterior, middle and upper third posterior cranial fossae); thus, offering a multi-corridor approach to complex skull base lesions. The one-piece and two-piece fronto-temporo-orbitozygomatic craniotomies are two particularly notable variations that have stood the test of time. Selection between the two variations is mostly surgeon preference and comfort with the technique; however, there are certain indications that specifically suit each approach. Additionally, a pictorial review has been crafted to clearly illustrate the cuts to be made in both methods. CONCLUSION: Understanding the evolution of this craniotomy and surgical approach provides an insight into accessing complex skull base pathologies with minimal brain retraction via safe and viable corridors.

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PURPOSE: The aim of this study is to investigate the origin and course of the orbital fat arterial supply in the lower eyelid using traditional anatomy and three-dimensional computed tomography (CT). METHODS: Twenty-seven cadaver heads were infused with mercury sulfide contrast media through the ophthalmic artery, maxillary artery, transverse facial artery, and facial artery. CT images were obtained after contrast agent injection, three-dimensional CT scans were reconstructed, and the cadaver heads were dissected. RESULTS: Forty-five qualified hemifaces showed that the orbital fat arterial supply in the lower eyelid originates primarily from the inferomedial muscular trunk (IMT) of the ophthalmic artery and the orbital branch of the infraorbital artery. The medial branch of the IMT terminated at the medial fat pad (35.6%) or the orbital floor (64.4%). The lateral branch terminated at the inferior oblique (IO) muscle (28.9%) or the central and lateral fat pads (17.8%). In 53.3%, the lateral branch extended to the anterior part of the lateral fat pad and terminated in the orbital wall or the zygomaticoorbital foramina. The orbital branch of the infraorbital artery coursed between the orbital floor and the orbital fat, providing supply to the IO muscle, inferior rectus (IR) muscle, nasolacrimal duct, and orbital fat. CONCLUSION: This study elucidated the origin and course of the orbital fat arterial supply in the lower eyelid, which may help to avoid reducing the blood supply of the orbital fat pedicles during surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: In recent years, the endoscopic transorbital (TO) approach has gained increasing interest for the treatment of middle cranial fossa lesions. We propose a technical refinement to the conventional superior eyelid TO approach, which improves the surgical exposure and augments the working angles when targeting the opticocarotid region. METHODS: Four embalmed adult cadaveric specimens (8 sides) were dissected at the Laboratory of Surgical Neuroanatomy of our institution. A TO approach was performed, with removal of the anterior clinoid process and the lateral orbital rim. Subsequently, the MacCarty keyhole was drilled in the superolateral orbital wall. Given that the lesser sphenoid wing was already drilled in the conventional TO craniectomy, the opening of the keyhole was essentially a lateral extension of the craniectomy. RESULTS: The procedure was successfully conducted in all 4 orbits. Clinoidectomy was performed either before or after extending the craniectomy to the MacCarty point. Extending the craniectomy made anterior clinoidectomy easier, by increasing the surgical exposure, and allowing a more lateral entrance for the endoscope. The extension also facilitated frontal lobe retraction, and it facilitated the optic nerve and carotid artery manipulation. Postoperative computed tomography scans showed a minimal 10-mm craniectomy extension, which remained covered by the temporal muscle after reconstruction. CONCLUSIONS: The modified endoscopic TO approach with the extension of the craniectomy to MacCarty point improves surgical access and visualization of the opticocarotid region. This facilitates anterior clinoidectomy and optic nerve decompression. Although it implies judicious instrument manipulation and a larger incision size, further studies can define its potential benefits.

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BACKGROUND: Knowledge of the anatomy of the infraorbital artery (IOA) is crucial for the rejuvenation of the anterior medial aspect of the midface; however, studies adequately describing the anatomy of the IOA branches are lacking, and their connection with the ophthalmic artery branches remains unclear. OBJECTIVES: This study aims to elucidate the anatomical characteristics of the IOA in its deployment within the lower eyelid using three-dimensional (3D) technology, thereby offering an anatomical foundation for clinical surgical procedures. METHODS: An analysis was conducted on computed tomography scans of 132 cadaveric head sides post-contrast injection, utilizing the Mimics software for reconstruction. The study focused on examining the anastomosis of the IOA, its principal branches, and the branches emanating from the ophthalmic artery. RESULTS: The prevalence of type I IOA was observed at 38.6% (51/132), while Type II IOA was found in 61.4% (81/132) of cases. A 7.6% incidence (10/132) of IOA directly anastomosing with the angular artery was noted. The presence of palpebral branches (PIOA) was identified in 57.6% (76/132) of instances. In the lower eyelid, four distinct distribution patterns of IOA were discerned: The likelihood of Type I PIOA was 5.3%, whereas for Types IIA, IIB, and IIC PIOA, the probabilities were 8.3%, 32.6%, and 11.4%, respectively. The occurrence of the orbital branch of IOA was recorded at 41.7% (55/132). CONCLUSIONS: 3D technology can map IOA variants and identify the deployment patterns of IOA branches in the lower eyelid vascular vesicles at high resolution as a guide in clinical practice. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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