33 - Aesthetic orbital surgery

Abstract

The position of the orbits relative to each-other as well as other features of the face plays an important role in whether a face is viewed as normal or not. The position of the ocular globe relative to the skeletal framework of the bony orbit also contributes to a normal or abnormal facial appearance. Orbital dystopia refers to the malposition of the eyes along the vertical or horizontal planes and contributes to an abnormal facial appearance. Orbital dystopias do not occur as isolated events. They occur secondary to primary processes that interfere with normal growth and development, such as facial clefts, craniosynostosis or encephaloceles. Orbital dystopias require surgical correction of orbital asymmetry. This poses a challenge to the craniofacial surgeon given the complex relationship between the ocular globe and its bony orbit, the need to restore symmetry with its counterpart, the nasal deformity inherently associated with orbital deformity, and the location of the orbit between the intracranial and extracranial space. In his seminal articles, Paul Tessier introduced the basic principles of orbital surgery. Fundamental procedures of orbital surgery include the box osteotomy, facial bipartition and orbital segmentation. The advent of computer-assisted surgical guides can improve the execution of the procedure, but ultimately, the results are dependent on the surgeon’s ability to visualize the ideal in all three dimensions and the technical execution of a complex movement. Correction of orbital deformities is an important component of providing facial symmetry, and can be tailored to meet the patient’s needs and give the surgeon the ability to correct a number of conditions of varied etiology having facial imbalance and asymmetry.