Wan Derrick C, Levi Ben, Kawamoto Henry, Tanna Neil, Tabit Christina, do Amaral Cassio Raposo, Bradley James P
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095, USA.
J Craniofac Surg. 2012 Jan;23(1):113-7. doi: 10.1097/SCS.0b013e318240fa84.
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.
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.
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).
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.
眶距增宽症与多种先天性畸形相关。手术矫正的合适时机仍存在争议。我们报告了33例接受面部二分法或眶箱截骨术治疗眶距增宽症患者的长期经验。
对接受面部二分法或眶箱截骨术及重新定位且有长期随访的眶距增宽症患者进行研究（n = 33）。记录首次手术时的年龄、术前内眦间距和术后即刻内眦间距。在术后随访时确定复发情况，并记录二次矫正的必要性。还评估了医生满意度评分（范围为0 - 4）。
患者的平均总随访时间为14.0年。关于初次手术时的年龄，6岁以下的患者均出现复发，83%接受了翻修手术。6岁及以上的患者中，只有11%出现复发并需要二次手术。然而，满意度评分相似（分别为3.2和3.5）。关于眶距增宽症的严重程度，轻度眶距增宽症（眶间距离[IOD]，30 - 34 mm）患者未出现复发。中度眶距增宽症（IOD，35 - 40 mm）患者中，29.4%出现复发。相比之下，所有重度眶距增宽症（IOD，>40 mm）患者均出现复发，需要重复矫正。满意度评分相似（分别为3.4、3.3和3.1）。
眶距增宽症手术后的复发与矫正时患者的年龄及术前严重程度有关。可能的话，眼眶的手术重新定位应推迟至儿童后期。
