Treatment considerations for hypertelorism correction in unique craniofacial clefts

Abstract

Background: Orbital hypertelorism is defined as an increased distance between both the medial and lateral aspects of the orbits and is a condition associated with a number of congenital midline anomalies, including surgically challenging midline cleft anomalies. The extent and location of facial widening dictates which procedure is performed: box osteotomies versus facial bipartition. Objectives: The objective of this presentation is to elucidate the key clinical findings and optimal surgical protocol for children with hypertelorism secondary to unique craniofacial clefts. Methods: Two brothers with similar albeit unique craniofacial cleft deformities and hypertelorism were surgically treated by the aforementioned authors at the Ark-La-Tex Craniofacial and Cleft Center. Presurgical treatment planning involved analysis of contrast computed tomography with three-dimensional (3D) reconstruction with 1 mm cuts, construction of 3D stereolithographic models, ophthalmology exam, genetics evaluation and orthodontic assessment. Factors including degree of hypertelorism, presence of dystopia, width and projection of nasal dorsum, presence of maxillary constriction, and finding of soft tissue excess or blemishes were used to direct surgical treatment planning. Findings: Although myriad points of analysis were used, of the preoperative patient factors discussed, presence of maxillary constriction and width and projection of the nasal dorsum were the most important aspects in the decision making process to perform box osteotomies versus facial bipartition. Conclusion: The craniofacial surgeon must have a thorough understanding of the indications and treatment modalities available for treatment of hypertelorism secondary to unique facial clefting conditions. Central to this understanding is a thorough clinical and radiographic work-up.