The Principles of Surgical Treatment of Hypertelorism.

Lee, Yoon Ho; Lee, Eul Tae

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 1999;26(1):58-67.
Published online January 1, 1999.

The Principles of Surgical Treatment of Hypertelorism.

Yoon Ho Lee, Eul Tae Lee

¹Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University.
²Department of Plastic and Reconstructive Surgery, College of Medicine, Inje University.

Abstract

From 1988 to 1998, the authors experienced 5 cases of hypertelorism and have settled some principles of surgical correction. Our surgical principles are as follows; First, the surgical approach method is determined by severity of the deformity. The severity is classified as mild, moderate and severe cases according to the deviation from age and gender matched Korean standards obtained from axial CT scan. We performed soft tissue surgery, subcranial approach, and intracranial approach for mild, moderate and severe cases, respectively. Second, medial wall osteotomy is appropriate for the interorbital hypertelorism, which means increased interorbital distance(IOD) with normal lateral orbital distance(LOD). The technical details of the operation are as follows; First, for medial orbital osteotomy, paramedian resection is applied to Munro type A, B medial orbital deformities. Second, for lateral orbital osteotomy, sagittla splitting of the lateral orbital wall and anterior transposition of the temporalis muscle is performed to prevent temporal hollowing (hour glass deformity). Third, to eliminate the nasofrontal communication and resultant ascending infection, we applied a modification of four layer sealing technique' originally developed by the authors. One of the most difficult problems in correction of the orbital hypertelorism is the excessive skin of nasal dorsum after medialization of the orbit. To address this problem, we only augmented the nasal dorsum and glabella by onlay bone graft and did not excise the excessive skin. We expect that redraping of widely undermined skin over the augmented nasal skeleton, redistribution of the elastic skin of children, and later growth of the nasal skeleton will allow the excessive skin of nasal dorsum to be corrected without excision and extemal midline scarring. At least, small amount of skin excision at medial canthal area will be able to resolve the skin excess at the time of secondary medial canthopexy. We expect that secondary medial canthopexy - which is usually required due to postoperative medial canthal drift-and correction of the enophthalmos can be done through trimming of the excessive skin at medial canthal area, hopefully after 12 years of age. (after the growth of nasal skeleton).

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