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Controversy on the Age of Hypertelorism Correction

Medra, Ahmed Mohamed MD*; Hassanein, Ahmed Gaber MD†,‡; Fadle, Khalid Nasser MD§

doi: 10.1097/SCS.0000000000005625
Clinical Study: PDF Only

Introduction: Orbital hypertelorism (HTO) is a challenging craniofacial problem seen in association with some congenital deformities. The age of HTO correction is a matter of debate.

The Aim of the work: to evaluate the outcome of HTO correction and determine the optimal timing for intervention, striving for the earliest possible intervention with the lowest relapse.

Patients and methods: A standard craniofacial approach with medial bone resection, 4 walls orbital box osteotomy and orbital medialization were done for all patients. Skeletal and soft tissue procedures were done as indicated.

Results: there were 10 patients aging 6 to 19 years. Seven were associated with craniofacial clefts, and 3 with craniosynostosis syndromes. HTO was severe in 8 cases and moderate in 2 cases. It was asymmetric in 2 cases. Frontoorbital remodeling was done in 3 cases with craniosynostosis. Failed surgery was reported in 2 cases. A redo surgery was done for one of them with an excellent outcome, while refused by the other. Nine patients had an excellent outcome. The mean level of satisfaction was 93.37%. Three patients had ugly facial scars. No major complications were recorded.

Conclusion: The time for surgical treatment of HTO is determined by the severity of the associated deformity. If there is an urgent factor indicating intervention, early correction can be performed exceptionally; otherwise, HTO correction should be performed after the age of 6 years.

*Cranio-Maxillo-Facial and Plastic Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria

Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt

Maxillofacial Surgery Department, Faculty of Dentistry, Al-Baha University, Kingdom of Saudi Arabia

§Neurosurgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt.

Address correspondence and reprint requests to Ahmed Gaber Hassanein, MD, Address: Maxillofacial Surgery Unit, General Surgery Department, Sohag Faculty of Medicine, Sohag, Egypt; E-mail:

Received 2 August, 2018

Accepted 10 April, 2019

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 by Mutaz B. Habal, MD.