Hypertelorism Corrected by Facial BipartitionImproves Exotropia
Kevin Chen, MD1, Priya Duvvuri, BA1, Alexander Gibstein, BA1, Bruce Nakfoor2, Mark Fisher, MD1, Henry Kawamoto, MD, DDS3, James P. Bradley, MD1.
1Hofstra Northwell School of Medicine, New York, NY, USA, 2University of Notre Dame, Notre Dame, IN, USA, 3UCLA, Los Angeles, CA, USA.
Background: Derangement in periorbital anatomy including absent ocular muscles, excyclorotation of the muscle, and instability of muscle pulleys in patients with hypertelorbitism may be responsible for eye motility disorders. Strabismus and exotropia are common ocular abnormalities in patients with Crouzon, Apert, and wide, median and paramedian rare craniofacial cleft, however the sequelae of these pathologies after corrective orbital surgery has been poorly studied. We detailed perioperative ophthalmologic exams and imaging to characterized functional outcomes after facial bipartition surgery.
Methods: Patients with hypertelorbitism who underwent facial bipartition surgery were studied specifically for eye motility disorders. We separated patients into craniofacial dysostosis (CFD) (74) and median or paramedian craniofacial clefts (CFC) (n=34). Preoperative and postoperative (3-6 months) ophthalmologic exams (including depth perception test), CT scans, and MRIs performed were used for analysis. 36% of MRIs had adequate imaging to assess angulation/degree of rotation of EOM, and compared to age-matched controls. Student’s T test and chi-square analysis determined significance of changes.
Results: 88% of preoperative craniofacial cleft patients had strabismus, with exotropia being the predominant form. The mean IDD was 39mm+4 preoperatively. Postoperatively, only 29% of patients had residual strabismus and mean IDD was 17 mm. 55% of craniodysostosis patients had strabismus, again with exotropia being the predominant form. The mean IDD was 37mm+3 preoperatively. Postoperatively, only 14% were noted to continue have strabismus and mean IDD was 17mm.
Conclusions: Surgical correction of hypertelorbitism is known to result in aesthetic periorbital improvement; in addition, it can now be said that eye motility disturbance can be objectively improved or even corrected with facial bipartition surgery. Vision problems related to exotropia should be considered a functional indication for facial bipartition surgery in patients with hypertelorbitism.
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