title: Correction of hypertelorbitism:  evaluation of relapse on long-term follow-up.
abstract: BACKGROUND
  Hypertelorbitism has been associated with a variety of congenital deformities. Appropriate timing for surgical correction remains controversial. We present our long-term experience of 33 patients with hypertelorbitism undergoing facial bipartition or orbital box osteotomy.
  
  
  METHODS
  Patients with hypertelorbitism treated with either facial bipartition or orbital box osteotomy and repositioning who had long-term follow-up were studied (n=33). Age at the time of first surgery, preoperative interdacryon distance, and immediate postoperative interdacryon distance were recorded. Relapse was determined on postoperative follow-up, and the need for secondary correction was noted. Physician satisfaction score (range, 0-4) was also assessed.
  
  
  RESULTS
  Patients had a mean total follow-up of 14.0 years. With regard to age at the time of initial procedure, patients younger than 6 years were all noted to have relapse, and 83% underwent revision surgery. In patients 6 years or older, only 11% had relapse and required a second operation. Yet, satisfaction scores were similar (3.2 versus 3.5). With regard to the severity of hypertelorbitism, there was no relapse noted among patients with mild hypertelorbitism (interorbital distance [IOD], 30-34 mm). Among those with moderate hypertelorbitism (IOD, 35-40 mm), 29.4% developed relapse. By contrast, all patients with severe hypertelorbitism (IOD, >40 mm) were noted to have relapse requiring repeat correction. Satisfaction scores were similar (3.4 versus 3.3 versus 3.1).
  
  
  CONCLUSIONS
  Relapse after surgery for hypertelorbitism is related to the age of the patient at correction and the preoperative severity. When possible, surgical repositioning of the orbits should be delayed until later childhood.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095, USA.
authors.forename: Derrick C
authors.initials: DC
authors.lastname: Wan
authors.forename: Ben
authors.initials: B
authors.lastname: Levi
authors.forename: Henry
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.forename: Christina
authors.initials: C
authors.lastname: Tabit
authors.forename: Cassio Raposo
authors.initials: CR
authors.lastname: do Amaral
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000367:Age Factors; D001860:Bone Plates; D001863:Bone Screws; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005004:Ethmoid Bone / Q000601:surgery; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D006972:Hypertelorism / Q000145:classification / Q000601:surgery*; D007430:Intraoperative Care; D008137:Longitudinal Studies; D008437:Maxilla / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D009915:Orbit / Q000601:surgery; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome