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Surgical Strategies for Soft Tissue Management in Hypertelorbitism

Raposo-Amaral, Cassio Eduardo MD, PhD; Denadai, Rafael MD; Ghizoni, Enrico MD, PhD; Raposo-Amaral, Cesar Augusto MD

doi: 10.1097/SAP.0000000000000915
Head and Neck Surgery

Background Although craniofacial bone correction is the essential step in hypertelorbitism correction, the final result depends on the management of soft tissue deformities. The purpose of this study was to review our surgical strategies for soft tissue reconstruction in hypertelorbitism correction.

Methods A retrospective study was performed of consecutive patients with hypertelorbitism, undergoing hypertelorbitism correction between 2007 and 2014. All aspects related to the craniofacial surgical procedures (number and type of procedures, outcomes, and complications) were verified through medical records, clinical photographs, and interviews with all patients. The surgical results were classified based on a previously published outcome grading scale I-IV on the need for additional surgery.

Results The present study included 16 patients diagnosed with Crouzon syndrome (n = 2), Apert syndrome (n = 1), encephalocele (n = 1), frontonasal dysplasia (n = 2), craniofrontonasal dysplasia (n = 5), Tessier number 10 type (n = 1), and Tessier number 0 to 14 type (n = 4).The number and types (local flaps, medial canthopexy, Converse scalping flap, and/or the K stitch technique) of surgeries performed varied according to the facial soft tissue deformities of each patient. The overall rate of surgical results ranked according to the need for additional surgery was 1.56 ± 0.51 (between categories I and II).

Conclusions As hypertelorbitism has been associated with a variety of congenital deformities, plastic surgeons who deal with these patients should have a broad surgical armamentarium tailored to each individual presentation.

From the *Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil; and †Division of Pediatric Neurosurgery, Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.

Received February 18, 2016, and accepted for publication, after revision August 14, 2016.

Funding: 2015/12852-7, São Paulo Research Foundation (FAPESP).

Conflicts of interest and sources of funding: none declared.

Abstract presented at 16th Congress of International Society of Craniofacial Surgery (ISCFS) 2015 held at Hilton Tokyo Bay Hotel, Maihama, Japan from September 14th-18th.

Reprints: Cassio Eduardo Raposo-Amaral, MD, PhD, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo 13084-880, Brazil. E-mail:

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