Improving results in orbital hypertelorism correction.

Between 1971 and 1977, 40 patients with orbital hypertelorism were operated on by the craniofacial team in Toronto. Results have improved as a result of this experience. Tomography in two planes has revealed four types of medial orbital wall deformity. Cephalographs proved inadequate to understand this three-dimensional problem. Mobilization of the orbits and their correct realignment, with removal of the precise amount of interorbital bone, are only preliminary steps in producing good results. Different techniques for reattachment of the medial canthal ligament, correct orientation of the lateral canthus, changes in methods of nasal excision, and the elimination of other facial or eyelid scars are helping to produce more normal looking patients. Simultaneous major intraoral procedures have been the greatest source of complications. Limitation of this surgery to one team has given sufficient experience to enable a diminution in morbidity and a halving in blood loss and time taken for the operation.