title: Hypertelorism correction:  what happens with growth? Evaluation of a series of 95 surgical cases.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Paris, France; and Amman, Jordan From the Craniofacial Unit, Hôpital Necker Enfants Malades, Surgical Office.
authors.forename: Daniel
authors.initials: D
authors.lastname: Marchac
authors.forename: Shawkat
authors.initials: S
authors.lastname: Sati
authors.forename: Dominique
authors.initials: D
authors.lastname: Renier
authors.forename: Jordan
authors.initials: J
authors.lastname: Deschamps-Braly
authors.forename: Alexandre
authors.initials: A
authors.lastname: Marchac
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005147:Facial Bones / Q000002:abnormalities / Q000254:growth & development / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006972:Hypertelorism / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D055815:Young Adult
references.citation: Tessier P, Guiot G, Rougerie J, Delbet JP, Pastoriza J. Osteotomies cranio-naso-orbito-facial osteotomies: Hypertelorism (in French). Ann Chir Plast. 1967;12:103–118.
references.citation: Tessier P. Experiences in the treatment of orbital hypertelorism. Plast Reconstr Surg. 1974;53:1–18.
references.citation: Munro IR, Sabatier RE. An analysis of 12 years of craniomaxillofacial surgery in Toronto. Plast Reconstr Surg. 1985;76:29–35.
references.citation: Mulliken JB, Kaban L, Evans C, Strand RD, Murray JE. Facial skeletal changes following hypertelorism correction. Plast Reconstr Surg. 1986;77:7–16.
references.citation: Kawamoto HK, Heller JB, Heller MM, et al.. Craniofrontonasal dysplasia: A surgical treatment algorithm. Plast Reconstr Surg. 2007;120:1943–1956.
references.citation: Raposo-Amaral CE, Raposo-Amaral CM, Raposo-Amaral CA, Chahal H, Bradley JP, Jarrahy R. Age at surgery significantly impacts the amount of orbital relapse following hypertelorism correction: A 30 year longitudinal study. Plast Reconstr Surg. 2011;127:1620–1630.
references.citation: Greig DM. Hypertelorism: A hitherto undifferentiated congenital craniofacial deformity. Edinburgh Med J. 1924;31:560–593.
references.citation: Tessier P. Orbital hypertelorism: I. Successive surgical attempts, material and methods: Causes and mechanism. Scand J Plast Reconstr Surg. 1972;6:135–155.
references.citation: Converse JM, Ransohoff J, Mathews ES, Smith B, Molenaar A. Ocular hypertelorism and pseudohypertelorism: Advances in surgical treatment. Plast Reconstr Surg. 1970;45:1–13.
references.citation: Morin JD, Hill JC, Anderson JE, Grainger RM. A study of growth in the interorbital region. Am J Ophthalmol. 1963;56:895–901.
references.citation: van der Meulen J. Medial faciotomy. Br J Plast Surg. 1979;32:339–342.
references.citation: Tessier P. Anatomical classification facial, cranio-facial and lateral-facial clefts. J Maxillofac Surg. 1976;4:69–92.
references.citation: Gunther H. Konstitutionelle Anomalien des Augenabstandes und der Interorbitalbreite. Virchows Arch Pathol Anat. 1933;290:373–384.
references.citation: Whitaker LA, Bartlett S, Shut L, Bruce D. Craniosynostosis: An analysis of the timing, treatment, and complications in 164 consecutive patients. Plast Reconstr Surg. 1987;80:195–212.
references.citation: Moreira Gonzalez A, Elahi M, Barakat K, Yavuzer R, Brinkmann B, Jackson IT. Hypertelorism: The importance of three-dimensional imaging and trends in the surgical correction by facial bipartition. Plast Reconstr Surg. 2005;115:1537–1546.
references.citation: Marchac D, Renier D. Fibrin glue in craniofacial surgery. J Craniofac Surg. 1990;1:32–34.
references.citation: Tessier P, Guiot G, Derome P. Orbital hypertelorism: II. Definite treatment of orbital hypertelorism (OR.H) by craniofacial or by extracranial osteotomies. Scand J Plast Reconstr Surg. 1973;7:39–58.