Orbital dystopia: assessing surgical outcome

ABSTRACT

The management of orbital dystopia has ranged from camouflage procedure for minor deformity to vertical translocation of the displaced orbit for severe deformity. The purpose of this study is to provide a guideline for the selection of an appropriate surgical treatment according to the degree of the dystopia. Since 1989, 18 patients with orbital dystopia have been treated for all cosmetic reasons. There were 13 females and 5 males aged from 8 to 46 years (mean 18.8 years). Underlying pathology in our cases included traumatic (orbital floor and wall fractures and irradiation)(44%); congenital (cleidocranial dysostosis, dermoid cyst, facial clefts and idiopathic causes)(40%); and fibrous dysplasia(16%). In the coronal plane, thr orbital displacement ranged from 2 to 7 mm(mean 3.9 mm). Patients were grouped into severe(n=8), moderate(n=6), and mild(n=4) degree of dystopia. Orbital repositioning, such as vertical repositioning of the functional orbit, bone shaving, autogenous bone graft and alloplastic material implantation were performed in severe cases(>4 mm). Various eye leveling technique, such as autogenous bone onlay graft, alloplastic material implantation, medial and superior rotation of zygoma, and medial and lateral canthoplasties were performed in moderate (3 mm) and mild (< 2 mm) cases. The postoperative surgical result was assessed by ordinary scale method cephalometric analysis. There was no visual loss, infection, epilepsy, or asethetic complication. The preoperative findings of orbital dystopia were corrected or significantly improved following surgery in all patients after an average follow-up period of 59.2 months. The result of this study indicate that our method of surgical correction of vertical orbital dystopia according to the degree of the dystopia is resonably safe, rewarding and worthwhile to the patients.