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Hypertelorism Correction: What Happens with Growth? Evaluation of a Series of 95 Surgical Cases

Marchac, Daniel M.D.; Sati, Shawkat M.D.; Renier, Dominique M.D.; Deschamps-Braly, Jordan M.D.; Marchac, Alexandre M.D.

Plastic and Reconstructive Surgery: March 2012 - Volume 129 - Issue 3 - p 713–727
doi: 10.1097/PRS.0b013e3182402db1
Pediatric/Craniofacial: Original Articles

Background: This report documents the authors' experience with 95 hypertelorism corrections performed since 1971. The authors note their findings regarding outcomes, preferred age at surgery, technique, and stability of results with growth.

Methods: Patients were classified into three groups: midline clefts (with or without nasal anomalies, Tessier 0 to 14); paramedian clefts (symmetric or asymmetric with or without nasal anomalies); and hypertelorism with craniosynostosis. The authors developed a hypertelorism index to measure longitudinal orbital position.

Results: A total of 70 box osteotomies were performed. Twelve of 95 patients had a bipartition. Six of 95 patients underwent a unilateral orbital box displacement or a three-wall mobilization, and seven of 95 had a medial wall osteotomy. Eighty patients were graded 1 to 4 using the Whitaker scale. Fifty-nine of 80 patients received a grade of 1, 15 patients received a grade of 2, five patients received a grade of three, four patients initially scored a 4, and three patients underwent reoperation and were rescored as 1. The authors developed a hypertelorism index to rate 28 patients with long-term follow-up. None showed deterioration of results over the long term. The complication rate was 4 percent.

Conclusion: The most interesting finding was that an initially good result in terms of orbital correction, whatever the severity, remains good with time, and facial balance improves after completion of growth.


Paris, France; and Amman, Jordan

From the Craniofacial Unit, Hôpital Necker Enfants Malades, Surgical Office.

Received for publication May 10, 2011; accepted September 21, 2011.

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

Daniel Marchac, M.D.; Plastic Surgery Office, 130 Rue de la Pompe, 75116 Paris, France,

©2012American Society of Plastic Surgeons