Surgical treatment of orbital hypertelorism: Historical evolution and development prospects

Abstract

Orbital hypertelorism (OR.H) is defined as an abnormal increase in the distance between the two orbits secondary to a skeletal anomaly, and it occurs in association with numerous congenital craniofacial malformations. Since its description by Greig in 1924, OR.H and the associated corrective procedures have captivated many surgeons. Here we present a discussion of the historical evolution of surgery for OR.H and highlight its future prospects. In the mid-twentieth century, only cover-up techniques simulating approximation of the eyes via an optical illusion were used, such as frontonasal skin resection, epicanthal fold surgery, and rhinoplasty. Subsequently, numerous surgeons attempted to correct the deformation using orbitonasal osteotomies via an extracranial approach. However, the outcomes were largely inadequate. Finally, in 1967, Tessier developed an efficient two-stage technique for OR.H correction via an intracranial approach; this technique revolutionized the management of OR.H. In 1970, Converse refined Tessier's procedure by performing a one-stage surgery that preserved olfaction. In 1976, Van Der Meulen developed the facial bipartition technique, which simultaneously corrected maxillary and craniofacial deformities. Box osteotomies and facial bipartition are still used for the correction of OR.H. Using the technological advancements introduced in the early 2000s, several surgeons have attempted to improve these techniques with the use of three-dimensional (3D) surgical planning, preoperative 3D printing, augmented reality-based surgical navigation, and computer assisted surgery using cutting guides. These modern-day practices are rapidly developing and are expected to refine and standardize the surgical correction of OR.H in the future.

Keywords: Box osteotomies; Computer assisted surgery; Craniofacial surgery; Facial bipartition; Orbital hypertelorism.