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Correcting Orbital Hypertelorism With Supraorbital Bipartition Osteotomy: Technique and Advantages

Ulma, Raquel M. DDS, MD; Aly, Hazem Maher MD; Vercler, Christian J. MD; Buchman, Steven R. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 41
doi: 10.1097/01.GOX.0000584428.12326.93
Craniofacial Abstracts
Open

University of Michigan - C. S. Mott Children’s Hospital, Ann Arbor, MI

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

INTRODUCTION: Orbital hypertelorism can exist in a variety of craniofacial anomalies such as midline anterior encephaloceles, frontonasal dysplasia, and syndromic bicoronal craniosynostosis. Facial bipartition corrects hypertelorism and benefits patients with a narrow, V-shaped maxilla. However, in young children with hypertelorism, there is a higher risk of injury to dental follicles. The supraorbital bipartition allows for correction hypertelorism in this younger population of patients undergoing frontal craniotomy without the need for osteotomies extending into tooth-bearing segments of the maxilla.

MATERIALS AND METHODS: The supraorbital bipartition technique was performed in 15 patients with hypertelorism. Of these, 3 patients had associated meningoencephaloceles, 5 patients had facial clefting, and 7 patients had hypertelorism associated with Crouzon or Apert syndrome. All patients underwent preoperative evaluation by neurosurgery, ophthalmology, and pediatrics. Neuropsychiatric testing and preoperative computerized tomography scans were performed. The technique, advantages, and complications are described.

RESULTS: The patient age ranged from 8 months to 8 years old, with a mean of 40 months. Seven patients were female, and 8 were male. All cases were uneventful. The interorbital distance was normalized for age in 11 cases. The remainder 4 cases had dramatic improvement in interorbital distance. Blood loss ranged from 250 to 600 ml, with mean EBL of 350 ml. Blood transfusion was required in 12 patients. No major complications occurred. In 4 cases, unilateral detachment of the medial canthal ligament occurred. In one case, bilateral detachment of the medial canthal ligament occurred. In all cases, these detachments were repaired intraoperatively. Two cases had minor wound dehiscence that healed with local wound care.

CONCLUSIONS: The classical techniques for management of hypertelorism entail either complete bilateral orbital osteotomies and translocation or facial bipartition. These techniques are not suitable for younger patients given the presence of tooth buds before the eruption of permanent dentition. In the proposed technique, the infraorbital osteotomy was avoided, thus sparing the developing tooth buds. The rate of complication of the present technique is lower than in the other techniques, with no major complications. The improvement in interorbital distance is comparable to that obtained with classical techniques.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.