Orbital Hypertelorism occurs during prenatal development when the face is forming. In normal development, the eye sockets (orbits) develop laterally and rotate to their normal midline position. In Orbital Hypertelorism, the orbits fail to rotate into their normal position, resulting in wide-set eyes with extra bone between the eyes.
A variety of conditions can lead to Orbital Hypertelorism, including encephaloceles, gliomas, midline dermoid cysts, orofacial clefts, and enlarged sinuses. When orbital hypertelorism is identified in an infant, a CT scan should be performed to determine the underlying etiology.
|TREATMENT & MANAGEMENT|
Treatment of Orbital Hypertelorism requires moving the bony orbits into a more natural medial position. Management of this condition requires an experienced multidisciplinary team including craniofacial surgeons and neurosurgeons. An incision is made within the hairline for access to the bony orbits. The craniofacial surgeon works in tandem with the neurosurgeon to access the orbits and osteotomies (bony cuts) are performed in order to place the orbits closer together. These are held in place using a combination of resorbable plates and screws, and/or steel wires. Depending on the technique utilized and the age of the patient, an osteotomy of the palate may be required as well, creating a gap between the maxillary central incisors. The most common techniques are known as a facial bipartition procedure, or orbital box osteotomies. The scalp incision is closed with dissolvable sutures and is well hidden once the hair grows back. Surgical correction can be performed at 5 years of age or older; care is taken to avoid injury to the developing tooth roots. Patients may require secondary procedures to rebalance the eyes and lids, improve tear drainage, or further optimize the aesthetics of the nose. Orthodontic treatment may also be indicated as necessary.