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A new technique for the correction of orbital hypertelorism
Author(s) -
Converse John Marquis,
WoodSmith Donald
Publication year - 1972
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-197208000-00009
Subject(s) - hypertelorism , orbit (dynamics) , medicine , anatomy , skull , coronal plane , frontal bone , deformity , osteotomy , surgery , engineering , aerospace engineering
Orbital hypertelorism is one of the most severe congenital deformities, frequently achieving monstrous proportions because of the wide divergence between the ocular globes. It is complicated by ocular anomalies; prominent among which are strabismus and amblyopia. The etiology is for the most part congenital although traumatic hypertelorism is seen and careful differentiation must be made between the true and false varieties of the deformity. The basis of intercanthal distance is a poor criterion of hypertelorism and we prefer the use of the distance between the anterior lacrimal crests as a more reliable means of measurement and have checked all our cases by the use of anterior‐posterior skull laminagrams. The surgical technique used is based on that developed by Tessier and his associates in 1967; the original two‐stage procedure has been replaced by a one‐stage modification of this operation introduced by us (Converse, et al. , 1970) with preservation of olfaction. The operation consists of raising a large scalp flap through a coronal incision with removal of a major portion of the frontal bone which is subsequently replaced. The frontal lobes are raised from the anterior cranial fossa exposing the roof of each orbit and the subperiosteal elevation is extended over the lower portion of the frontal bone and contiguous orbital rims. Combined with an incision through the lower eyelid, exposure of the entire orbit on its inner aspect just anterior to the optic foramen is obtained and lines of osteotomy are made through the orbital walls and combined with resection of an appropriate central portion of bone to enable medial motion of the orbits. The bony defects are grafted with autogenous bone grafts and the soft tissues are replaced in position. Twenty‐five cases of orbital hypertelorism involving bilateral and unilateral hypertelorism are presented without unusual complications being observer. The orbits have been mobilized medially for a distance up to 40 millimeters without complications, and the operative procedures are all performed in collaboration with the neurosurgeon. Most patients have required subsequent extraocular muscle balancing surgery and correction of medial canthal deformities.