SYM5 The Nose in Orbital Hypertelorism: Review of a 44-Year Experience by a Single Surgeon

Abstract

Introduction: Paul Tessier once famously quipped that orbital hypertelorism correction was no more than an extended rhinoplasty, i.e., a normal nose could not be obtained unless the orbital cavities were in normal position. Operative options for surgical correction of orbital hypertelorism include box osteotomy and facial bipartition. Correction of nasal deformities must also be undertaken in order to create an acceptable aesthetic result; however, this is a difficult procedure. This study evaluates patient characteristics and post-operative outcomes in patients undergoing surgical correction of orbital hypertelorism and provides conclusions on the surgical management of hypertelorism on the basis of the senior author’s 44-year experience with orbital hypertelorism. Methods: All patients (n = 83) who underwent surgical correction of orbital hypertelorism between January 1, 1975 and January 1, 2019 were identified. A retrospective chart review was conducted by three independent reviewers to determine eligibility. Demographic information collected included age at time of surgery, gender, time to last follow up visit and procedure performed. Outcome measures included postoperative complications and follow-up operations. Results: 83 patients were identified to have undergone surgical correction of orbital hypertelorism. 36% of patients underwent follow-up procedures with the senior author. No complications such as CSF leaks or wound infections occurred. In addition to quantitative results of retrospective data analysis, examination of Dr. Tessier’s cases and the senior author’s experience shows that in cases where nasal reconstruction is done concomitantly with hypertelorism correction, a Gillies/Converse type scalping flap is required. Conclusion: The underlying cause of hypertelorism is heterogenous. It is a symptom, not a diagnosis. On the basis of a 44-year experience with orbital hypertelorism, the following conclusions can be drawn: 1. Do not operate too early. 5 or 6 should be the minimum age because good results earlier than that have not been shown; 2. Parents should be told that repeat operations on the nose should be expected; 3. The paramedian forehead flap can be used for secondary rhinopoeses, but is not to be used if there is a fresh craniotomy beneath; 4. If a coronal incision is to be made by the neurosurgeons (as for example for closure of an encephalocoele), the plastic surgeon should be present to ensure that the incision will not burn the bridges for subsequent nasal reconstruction; 5. Moving the orbits is not difficult; getting a normal nose is; 6. One common characteristic in hypertelorism patients is a short nose which needs to be lengthened.