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Age at Surgery Significantly Impacts the Amount of Orbital Relapse following Hypertelorbitism Correction: A 30-Year Longitudinal Study

Raposo-Amaral, Cassio E. M.D.; Raposo-Amaral, Cassio M. M.D., Ph.D.; Raposo-Amaral, Cesar A. M.D.; Chahal, Harjit M.D., M.P.H.; Bradley, James P. M.D.; Jarrahy, Reza M.D.

Plastic and Reconstructive Surgery: April 2011 - Volume 127 - Issue 4 - p 1620-1630
doi: 10.1097/PRS.0b013e31820a6472
Pediatric/Craniofacial: Original Articles
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Background: The aim of this study was to identify variables that affect orbital relapse after hypertelorbitism correction.

Methods: The authors retrospectively reviewed the medical records of patients who underwent hypertelorbitism correction at a single institution between 1975 and 2005. Bony interorbital distance was measured postoperatively and at long-term follow-up. Orbital relapse was defined as the difference between bony interorbital distance measurements at these time points. Patients were stratified into groups based on age at primary surgical correction (early, <8 years; late, ≥8 years), the severity of the initial deformity (moderate, bony interorbital distance ≤40 mm; severe, bony interorbital distance >40 mm), and the type of surgical technique used (facial bipartition versus box osteotomy). Differences in relapse between the stratified groups were analyzed using paired t tests.

Results: A total of 22 patients met inclusion criteria for this study. Patients who underwent surgery before 8 years of age had a significantly higher degree of orbital relapse compared with older patients (5.9 mm versus 1.8 mm; p = 0.0142). There was no significant difference in orbital relapse based on the severity of the deformity or the operative technique used.

Conclusions: Surgical correction of hypertelorbitism in patients younger than 8 years leads to a significantly higher rate of bony interorbital distance relapse compared with patients who undergo surgery at an older age. Neither the initial degree of severity nor the type of surgical technique correlates with relapse. The authors therefore recommend that in the absence of urgent factors necessitating early intervention, hypertelorbitism correction should be performed after 8 years of age.

Campinas, Brazil; and Los Angeles, Calif.

From the Institute of Plastic and Craniofacial Surgery, Brazilian Society of Research and Assistance to Craniofacial Rehabilitation Hospital (SOBRAPAR), and the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles Medical Center.

Received for publication March 14, 2010; accepted October 15, 2010.

†In memoriam.

Presented in part at the 19th Congress of the European Association for Cranio-Maxillo-Facial Surgery, in Bologna, Italy, September 9 through 12, 2008.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Cassio E. Raposo-Amaral, M.D., Hospital de Crânio e Face SOBRAPAR, Av. Adolpho Lutz 100, Cidade Universitária, 13083-880. CP: 6028, Campinas, São Paulo, Brazil, cassioraposo@hotmail.com

©2011American Society of Plastic Surgeons