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Hypertelorism: The Importance of Three-Dimensional Imaging and Trends in the Surgical Correction by Facial Bipartition

Gonzalez, Andrea Moreira M.D.; Elahi, Mohammed M.D.; Barakat, Khaled M.D.; Yavuzer, Reha M.D.; Brinkmann, Ben M.D.; Jackson, Ian T. M.D.

Plastic & Reconstructive Surgery: May 2005 - Volume 115 - Issue 6 - pp 1537-1546
doi: 10.1097/01.PRS.0000160272.43382.F0
Original Articles: Reconstructive, Head/Neck

Background: The technique of facial bipartition has been considered a great advance in achieving a more natural appearance in hypertelorism correction.

Methods: Fourteen patients who had undergone hypertelorism correction by facial bipartition were retrospectively studied to analyze the role of three-dimensional computed tomographic reconstruction in the evaluation of the deformity and preoperative planning. The procedure and surgical details that can improve the outcome were described. A reproducible set of three-dimensional measurements that can help in preoperative patient evaluation was determined based on information obtained using the Analyze/AVW 3.1 system (Biomedical Imaging Resource, Mayo Foundation, Rochester, Minn.).

Results: In this series, the most common diagnosis was frontonasal dysplasia (64.3 percent). Five patients had second-degree (35.7 percent) and nine had third-degree hypertelorism (64.3 percent). The three-dimensional scans were shown to be highly accurate in predicting the degree of deformity. There was a significant difference in the preoperative and postoperative interdacryon distance and midface height (p < 0.05) but not in the bitemporal dis- tance (p = 0.08). The simulation correlated significantly with the postoperative result when interdacryon distance and midface height were analyzed (0.736 and 0.999).

Conclusions: Facial bipartition provided a three-dimensional correction of hypertelorism. Three-dimensional imaging can definitely be considered an extra tool for accurate surgical planning and helping the family understand the surgical procedure and the end result.

Southfield, Mich.; Ankara, Turkey; and Rochester, Minn.

From the Institute for Craniofacial and Reconstructive Surgery; the Department of Plastic and Reconstructive Surgery, Gazi University Medical School; and RTR, Department of Radiology, Mayo Clinic.

Received December 23, 2002; revised July 19, 2004.

Presented at the 13th Annual Meeting of the North American Skull Base Society, in San Diego, Califiornia, February 16 to 19, 2002, and at the 49th Annual Meeting of the Michigan Chapter of the American College of Surgeons, in Bellaire, Michigan, May 9 to11, 2002.

Ian T. Jackson, M.D., Institute for Craniofacial and Reconstructive Surgery, 16001 W. Nine Mile Road, Third Floor, Fisher Center, Southfield, Mich. 48084, ianjackson@juno.com

©2005American Society of Plastic Surgeons