Correction Of Orbital Hypertelorism Research Articles

Surgical Correction of Orbital Hypertelorism With Absorbable Plate Instead of Frontal and Orbital Bar and Inverted U-Shaped Osteotomy.

The aim of the study is to investigate the effect and feasibility of using absorbable plate instead of frontal and orbital bar and inverted U-shaped osteotomy to correct the widening of orbital distance. The surgical effect and feasibility of using absorbable plate instead of frontal and orbital bridge plus inverted U-osteotomy for orbital widening syndrome in seven cases between January 2019 and February 2022 were retrospectively analyzed. First, the surgical procedure for orbital hypertelorism was inverted U-shaped orbital osteotomy, and a frontal bone flap was removed, exposing the superior orbital margin and the orbital circumference, and the orbital bone was directly cut off by inverted U-shaped osteotomy. The widened bone in the middle of the orbit was removed, and a long absorbable plate was used to replace the orbitofrontal bridge. The two sides of the orbit were fixed on the absorbable plate, and the absorbable plate was fixed on the rear skull. The clinical effect of treatment, complications (such as cerebrospinal fluid leakage and infection), safety, and feasibility of surgery were evaluated. Using absorbable plate instead of fronto-orbital bridge achieved the effect of orbitofrontal bridge, without orbital distance widening, cerebrospinal fluid leakage, and intracranial infection. Operating time was reduced. There was no metal fixation, and there was no risk of a second operation. The effect of replacing the frontal-orbital bridge with an absorbable plate and inverted U-shaped osteotomy is positive, the operation time is short, and the orbital distance is clearly improved. This approach can replace the traditional orbital-distance operation, and the incidence of postoperative cerebrospinal fluid leakage and infection is low. Long-term follow-up results are stable.

An Effective Technique for the Correction of Orbital Hypertelorism to Prevent Recurrence.

To investigate the efficacy and safety of medial orbital wall osteotomy with medial displacement combined with lateral orbital wall Medpor artificial material implantation in the treatment of orbital hypertelorism. A retrospective analysis was performed on patients who underwent the above surgical procedures from 2010 to 2019, and long-term follow-up was conducted to record surgery-related complications and evaluate postoperative outcomes. Four patients (3 males and 1 female) were followed up for 24 months. All patients were satisfied with the postoperative results. There was no diplopia, vision loss, eye movement disorder or other vision-related complications. There was no implant rejection, infection or exposure. This operation is a modification of the traditional surgical method of medial orbital wall osteotomy. It is safe and effective for the treatment of orbital hypertelorism.

The value of virtual simulation for preoperative planning in surgical correction of orbital hypertelorism

The value of virtual simulation for preoperative planning in surgical correction of orbital hypertelorism

Reconstructive Operation of Severe Orbital Hypertelorism With Computer-Assisted Precise Virtual Plan.

Orbital hypertelorism correction is still a less precise procedure, with a simple preoperative design and surgical results often depending on the operator's experience. In recent years, computer-assisted technology has been fully utilized in craniofacial surgery. This article aims to explore the clinical results of computer-assisted technology in orbital hypertelorism correction and discuss its advantages and effects on treatment. Four patients with orbital hypertelorism underwent intracranial and extracranial combined box osteotomy correction. Preoperative computed tomography scans were performed, and 3-dimensional 3D digital technology was used to measure the orbital spacing, virtually design the 3D cutting scheme, and guide the intraoperative 3D cutting to improve the accuracy of periorbital osteotomy and reduce the surgical risk. Four patients underwent successful surgery, and the average distance of the medial orbital wall was decreased from 43.6 to 23.4mm. Computer-assisted box osteotomy shortens the operative time and provides better corrective results.

3D visualization and simulation in surgical planning of orbital hypertelorism

Background: simulation and three-dimensional visualization of object motion is a prerequisite for any surgical planning system. Orbital hypertelorism is a disease, which is most commonly associated with craniofacial malformations. We have developed a surgical planning system for planning and evaluation of orbital hypertelorism surgery. In our system CT-based virtual surface models fitted by oriented bounding boxes (OBB) are manipulated. Three-dimensional motion as well as a correction surgery can be simulated. Both are controlled by collision detection. The computer-based interactive surgery simulation systems (CISSS) presented here can take virtual surgical operation and forecast facial features after the correction of orbital hypertelorism.

A critical appraisal of surgical outcomes following orbital hypertelorism correction: what is the incidence of true bony relapse versus soft tissue telecanthus?

Orbital hypertelorism (OHT) represents a congenital condition defined by lateralization of the bony orbit, unlike soft tissue telecanthus in which there is an increase in intercanthal distance without true bony lateralization. Existing literature remains very limited in its postoperative assessment of bony versus soft tissue relapse, which may both clinically present as telecanthus. We performed a critical appraisal of the literature to determine the postoperative incidence of bony versus soft tissue relapse following OHT repair. The PubMed, MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, and clinicaltrials.org were searched systematically for all English studies published in any time frame reporting relapse rates following primary OHT repair. The primary outcome was incidence of bony and soft tissue relapse defined as orbital lateralization and medial canthal drift, respectively. The secondary outcome measures include postoperative complications, predictors of postoperative complications, timing and type of surgery, and revision rates. Eleven articles were included. A total of 84 (35.3%) patients experienced bony relapse while 43 (27.2%) patients experienced soft tissue relapse. Age at time of intervention (p < 0.92), severity at presentation (p < 0.90), and surgical technique (p < 0.09) were not found be significantly associated with relapse rate. Methods for long-term follow-up were not standardized, and there was no consistent measure to objectively assess telecanthus. There is no general consensus on predictive factors of long-term relapse following OHT repair in the form of box osteotomy or facial bipartition. These findings call for cross-sectional outcome standardization to better understand long-term outcomes across institutional, provider, and patient differences.

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

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.

Applications of 3D orbital computer-assisted surgery (CAS).

The purpose of the present report is to describe the indications for use of 3D orbital computer-assisted surgery (CAS). We analyzed the clinical and radiological data of all patients with orbital deformities treated using intra-operative navigation and CAD/CAM techniques at the Hôpitaux Universitaires de Genève, Switzerland, between 2009 and 2016. We recorded age and gender, orbital deformity, technical and surgical procedure and postoperative complications. One hundred and three patients were included. Mean age was 39.5years (range, 5 to 84years) and 85 (87.5%) were men. Of the 103 patients, 96 had intra-operative navigation (34 for primary and 3 for secondary orbito-zygomatic fractures, 15 for Le Fort fractures, 16 for orbital floor fractures, 10 for combined orbital floor and medial wall fractures, 7 for orbital medial wall fractures, 3 for NOE (naso-orbito-ethmoidal) fractures, 2 for isolated comminuted zygomatic arch fractures, 1 for enophthalmos, 3 for TMJ ankylosis and 2 for fibrous dysplasia bone recontouring), 8 patients had CAD/CAM PEEK-PSI for correction of residual orbital bone contour following craniomaxillofacial trauma, and 1 patient had CAD/CAM surgical splints and cutting guides for correction of orbital hypertelorism. Two patient (1.9%) required revision surgery for readjustment of an orbital mesh. The 1-year follow-up examination showed stable cosmetic and dimensional results in all patients. This study demonstrated that the application of 3D orbital CAS with regards to intra-operative navigation and CAD/CAM techniques allowed for a successful outcome in the patients presented in this series.

Effectiveness of a Novel Augmented Reality-Based Navigation System in Treatment of Orbital Hypertelorism.

Augmented reality (AR) technology can superimpose the virtual image generated by computer onto the real operating field to present an integral image to enhance surgical safety. The purpose of our study is to develop a novel AR-based navigation system for craniofacial surgery. We focus on orbital hypertelorism correction, because the surgery requires high preciseness and is considered tough even for senior craniofacial surgeon. Twelve patients with orbital hypertelorism were selected. The preoperative computed tomography data were imported into 3-dimensional platform for preoperational design. The position and orientation of virtual information and real world were adjusted by image registration process. The AR toolkits were used to realize the integral image. Afterward, computed tomography was also performed after operation for comparing the difference between preoperational plan and actual operational outcome. Our AR-based navigation system was successfully used in these patients, directly displaying 3-dimensional navigational information onto the surgical field. They all achieved a better appearance by the guidance of navigation image. The difference in interdacryon distance and the dacryon point of each side appear no significant (P > 0.05) between preoperational plan and actual surgical outcome. This study reports on an effective visualized approach for guiding orbital hypertelorism correction. Our AR-based navigation system may lay a foundation for craniofacial surgery navigation. The AR technology could be considered as a helpful tool for precise osteotomy in craniofacial surgery.

Coronal Synostosis Syndrome (Muenke Syndrome)

Muenke syndrome is a fibroblast growth factor receptor 3 (FGFR-3)-associated coronal craniosynostosis syndrome, which was first described in 1997. We report an infant girl who was born to a 29-year-old primapara at 38 weeks' gestation. When evaluated at 3 days old, physical examination revealed a high forehead with frontal bossing, upturned nose, arched palate, shallow midface structures, and heavily ridged coronal sutures bilaterally. Clinically, the infant seemed to be neurologically normal. Skull radiographs and computed tomography confirmed the presence of bilateral coronal synostosis, with patency of all other sutures. Family history was remarkable, in that the infant's father, paternal grandmother, and a paternal cousin demonstrated subtle craniofacial features, which had not been previously identified. Mutation analysis of FGFR-3 revealed a missense mutation in exon 6, c.749 C>G, with a resultant amino acid change from proline to arginine at codon 250 (P250R), in keeping with Muenke syndrome (Am J Hum Genet 1997;60:555-564). The mutation was subsequently identified in her father, suggesting variable expression in this family, as he had only mild midfacial flattening. At 9 months of age, our patient underwent anterior cranial expansion, correction of orbital hypertelorism, intracranial orbital osteotomies, and advancement of the frontal bandeau. She tolerated the procedure well and has done well postoperatively. We report the case of an infant with Muenke syndrome, with evidence of variable expressivity within the paternal family. The pertinent literature, in which only 2 prior Canadian cases were identified, is reviewed.

Refinement of the Correction of Orbital Hypertelorism

The objective of this article was to explore the effect of paraorbital soft-tissue expansion before orbital osteotomies and medial translocation by combined intracranial-extracranial approach. Tissue expansion was implanted in the zygomatic and temporal region 3 weeks before traditional operation in 2 cases of severe orbital hypertelorism. The measurements of interorbital and intercanthal distance were studied preoperatively and postoperatively by three-dimensional computed tomography. The interorbital distance of the 2 patients decreased from 4.4 and 3.2 cm to 2.0 and 1.4 cm, respectively. The intercanthal distance decreased from 6.7 and 4.8 cm to 5.0 and 3.8 cm, respectively. The paraorbital soft-tissue-expansion technique may be an effective technique for the stability of the corrected orbital framework and the prevention of reoccurrence in severe cases of orbital hypertelorism.

3D Visualization and Simulation in Surgical Planning System of Orbital Hypertelorism

Simulation and three-dimensional visualization of object motion is a prerequisite for any surgical planning system. Orbital hypertelorism is a disease, which is most commonly associated with craniofacial malformations. We have developed a surgical planning system for planning and evaluation of orbital hypertelorism surgery. In our system CT-based virtual surface models fitted by oriented bounding boxes (OBB) are manipulated. Three-dimensional motion as well as a correction surgery can be simulated. Both are controlled by collision detection. The computer-based interactive surgery simulation systems (CISSS) presented here can take virtual surgical operation and forecast facial features after the correction of orbital hypertelorism, our surgical planning is cheaper and faster than the current methods, surgical outcome was also better than the current methods.

Surgical Correction of Orbital Hypertelorism

From the Tampa Bay Craniofacial Center, Tampa, Florida. Received April 2, 2009. Accepted for publication April 2, 2009. Address correspondence and reprint requests to Mutaz B. Habal, MD, FRCS, FACS, Tampa Bay Craniofacial Center, Tampa, FL 33608; E-mail: [email protected]

Paul Louis Tessier

Paul Louis Tessier

Paul Louis Tessier

Paul Louis Tessier

Mucocele of the paranasal sinuses as a cause of acquired orbital hypertelorism: the second case

Background Orbital hypertelorism is defined as a lateralization of the total orbit. This condition is associated almost always with congenital abnormalities. An acquired total displacement of the orbit is almost impossible once the bony pillars of the craniofacial complex are established. The aim of this article was to discuss a case of a young man with paranasal sinus mucocele, who developed OHT. Case Description A 20-year-old man was admitted to us with orbital hypertelorism in 1993. The patient's examination revealed marked orbital hypertelorism, and no other abnormal finding was noted, and he had no congenital defect at birth. Hypertelorism was corrected by surgery, and we find that this condition was acquired secondary to paranasal sinus mucocele. Conclusion This is the second case of an acquired OHT secondary to paranasal sinus mucocele and the first in which the condition was corrected by surgery in late years of life. We found excellent correction of orbital hypertelorism 13 years after surgery. The authors discuss the possible link between mucocele and possible mechanism for the development of orbital hypertelorism and emphasize the need for early surgery and long-term follow-up.

Sclerotherapy of Craniofacial Venous Malformations: Complications and Results

The purpose of this study was to develop a methodology to quantify osseous, ocular, and periocular fat changes caused by correction of orbital hypertelorism to test the hypothesis that there is a quantitatively predictable relationship between the movement of the osseous orbit and that of the ocular globe. A retrospective review was performed of 10 patients who were status post unilateral or bilateral transcranial medial orbital translocation, for whom there were archival digital data for preoperative and postoperative (mean interval = 30 months) three-dimensional computed tomographic (CT) scans. In addition to standard demographic and surgical data, the clinical preoperative and postoperative interpupillary and intermedial canthal distances were recorded. By using a computer graphics workstation, the CT digital data were registered to four surgically unaltered anatomic fiducial points to allow longitudinal quantitative comparisons. The following three-dimensional measurements were made for each patient preoperatively and postoperatively: interdacryon and interocular centroid distances, and on a standard series of three horizontal and two vertical planes, the position of the medial and lateral orbital walls, and the thickness of the medial and lateral periorbital fat (20 orbits). CT digital distances were compared with similar clinical distances when possible. The age at operation ranged from 4.0 to 12.5 years (mean, 6.6 years). The reduction in interdacryon distance exceeded the reduction in intercentroid distance (mean interdacryon change = -5.3 mm versus mean intercentroid change = -2.7 mm). Although there was a strong correlation between the amount of reduction of the lateral orbital wall and intercentroid distances, there was only a moderate correlation between the reduction in the intercentroid distance and that of the medial orbital wall. Similarly, there was a moderate correlation between the decrease in thickness of the lateral periorbital fat and the reduction of intercentroid distance but not of the medial orbital fat. In conclusion, medial translocation of the orbit does not produce equivalent movement of the ocular globe; neither the intermedial canthal nor the interdacryon distance is a useful predictor of ocular centroid position; and if the goal of hypertelorism operation is reduction of interocular distance, then CT measurement of globe intercentroid distance is essential for outcome assessment.

An objective assessment of treatment for orbital hypertelorism.

A retrospective statistical analysis of orbital hypertelorism correction was performed by comparing the preoperative and postoperative intercanthal distances of these patients with published age-matched normal values. Forty-five patients who had undergone surgery over a 15-year period with an average follow-up of 5 years (6 months to 14 years) were evaluated. Comparison of age-normalized preoperative and postoperative intercanthal distances revealed a significant difference for orbital hypertelorism patients as a group (p < 0.0001), patients with clefts (p < 0.0001), patients with nasoencephalocele (p < 0.01), and patients with frontonasal dysplasia (p < 0.05), but not for those patients with craniofacial dysostosis (p < 0.20). Multiple analyses of variance revealed a significant interaction existing between the extent of preoperative deformity and the cause of hypertelorism for both the postoperative deformity and the total amount of correction achieved, but not for the type of surgery or for the age at which the surgery was performed.

The Skeletal Treatment of Orbital Hypertelorism

Orbital hypertelorism, strictly defined as an increase in bony interorbital distance, is not itself an isolated syndrome, but is instead an anomaly that may occur as either part of a syndrome or malformation sequence. Evaluation of orbital hypertelorism and the various anomalies that accompany it is best performed by a multidisciplinary craniofacial team. The timing of surgery involves considerations of multiple variables, but when performed can offer marked cosmetic improvements. Equally important as the skeletal surgery is correction of the associated soft-tissue problems.

Geometrical Planning for the Correction of Orbital Hypertelorism

Orbital hypertelorism may be associated with a variety of deformities affecting several elements of the craniofacial skeleton. Shortness of the central portion of the face represented by a wide, short nose and anterior open bite is frequently combined with the exaggerated interorbital distance. With the mobilization of the two halves of the face it is possible to approximate the orbits, simultaneously elongating the center of the face and normalizing the maxillary alveolar ridge. A technique is described to plan the operation geometrically in order to predict accurately the skeletal correction, the change of the inclination of the eye slant, and the modification of the axis of the teeth.