Long-Term Outcomes After Orbital Hypertelorism Correction: An Assessment of Objective Photogrammetric and Patient-Reported Outcomes.

Abstract

Orbital hypertelorism (OHT) can be corrected surgically utilizing a 4-wall box osteotomy, facial bipartition, or medial orbital composite unit translocation (MOCUT). However, the impact on periorbital symmetry and patient-reported outcomes (PROs) is less well known. This study assesses periorbital symmetry and PROs after OHT correction at long-term follow-up. Patients who underwent OHT correction at a single institution from 2000 to 2024 were identified. Hypertelorism index (HI) and periorbital symmetry was compared preoperatively, 1-year postoperatively, and at long-term follow-up (average 9 y postoperation), with a ratio of 1 considered perfect symmetry. FACE-Q surveys were administered postoperatively and converted to Rasch scores (0-100 scale). 30 patients were included, 7 of which completed the FACE-Q. 60.0% (n=18) were patients with frontonasal dysplasia, 17% (n=5) facial cleft, and 13% (n=4) with encephalocele. Seventy percent (n=21) underwent 4-wall box osteotomy, 17% (n=5) facial bipartition, and 13% (n=4) MOCUT. HI improved from preoperation (1.8±0.6) to 1-year (1.4±0.3) and long-term (1.4±0.3) postoperation (P<0.001). Palpebral height ratio was significantly worse 1-year (0.9±0.1 versus 1.0±0.2, P=0.03) and long-term (0.9±0.1 versus 1.0±0.2, P=0.02) postoperation compared with preoperation. At long-term follow-up, canthal tilt difference (4.3±4.9 versus 1.8±2.2 degrees, P=0.03) was significantly worse than preoperation. FACE-Q scores were low in domains of facial appearance with medians ranging from 16 (head shape)-32 (forehead). At long-term follow-up, hypertelorism shows stable and significant improvement with surgical correction. However, periorbital asymmetry worsened as shown by canthal tilt and palpebral height difference postoperatively. In addition, patient satisfaction with appearance remains low despite surgical intervention.