Bipartition osteotomy for treating orbital hypertelorism with maxillofacial malformation
10.3760/cma.j.cn114453-20200506-00263
- VernacularTitle:Bipartition截骨治疗眶距增宽症合并颌面部发育畸形
- Author:
Ioi Ka WONG
1
;
Min WEI
;
Zheyuan YU
;
Jie YUAN
;
Liang XU
;
Yijia ZHU
Author Information
1. 上海交通大学医学院附属第九人民医院整复外科，上海 200011
- Keywords:
Craniofacial abnormalities;
Congenital malformation;
Reconstructive surgical procedures;
Maxillofacial abnormalities;
Computer-aided design;
Orbital hypert
- From:
Chinese Journal of Plastic Surgery
2022;38(4):418-424
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the experience of Bipartition osteotomy combined with craniofacial bone remodeling in the treatment of orbital hypertelorism and midfacial dysplasia.Methods:A retrospective analysis was done by the clinical data of two patients with orbital hypertelorism with maxillofacial malformation treated in the Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in July 2005 and August 2018. The Bipartition osteotomy via intracranial approach were applied for the two patients, one male and one female. The two patients aged 17 and 19, were suffered from degree Ⅰ orbital hypertelorism [interorbital distance(IOD) 32 mm and 34 mm]. With a frontal bone fenestration, the Monobloc osteotomy was done firstly to dislocate the cranio-orbital-maxilla bone graft, then the Bipartition osteotomy was performed according to the preoperative design through 3D computer aided design(CAD) and a V-shape bone graft was removed from the interorbital bone graft to split the hard palate longitudinally along the midline. After all, the whole facial bone was separated to two blocks: bilateral orbital-maxillary segments. Finally the midface had been remodeled by the bilateral orbital-maxillary segments which rotated and fixed internally. Self-rib nasal augmentation was done later. Patents’ complications, eye movement, visual acuity, olfactory sensation, nasal shape, IOD were measured through CT scan and the appearances were observed in the postoperative follow-up to determine the degree of improvement.Results:15 mm in width of interorbital bone was resected in both of the two patients, respectively. Postoperative IOD reduced by 17 mm, 19 mm, respectively. Mild cerebrospinal fluid leakage occurred in both patients after operation. They recovered after 5, 8 days of pillow-free horizontal position, respectively. The male patient developed local skin infection at the coronal incision and recovered after dressing change for 1 week. One week after operation, the female patient’s nose tip was partially broken near the nasal columella, and recovered after debridement and repairment. Follow up for 4-11 months showed that the eye movement, visual acuity, normal convergence and olfactory sensation were normal and no diplopia of 2 patients. The nasal appearances and orbital hypertelorisum of them were corrected obviously by follow-up after 4 months, but the nasal morphology and epicanthus still need further improvement.Conclusions:The Bipartition osteotomy can effectively treat the orbital hypertelorisum through the internal rotation fixation of bilateral orbital-maxillary segments, that makes the high arch palate lower and the occlusal plane of the upper jaw flattened.
