Facial Bipartition with Gradual Orbital Contraction: Correction of Wide 0-14 Craniofacial Cleft
James P. Bradley, M.D.1, Henry K. Kawamoto, Jr., MD, DDS1, Cassio Raposo do Amaral, MD2, Hurig V. Katchikian, BS1.
1University of California, Los Angeles, Los Angeles, CA, USA, 2Sobrapar, Bahia, Brazil.
Purpose: Distraction osteogenesis has been shown to successfully lengthen hypoplastic bone and augment surrounding soft tissue. Compression or contraction of fractured or osteotomized bone has been shown to promote healing. Although correction of hypertelorbitism with an acute movement of facial bipartition segments has been shown to be effective, gradual contraction of the segments may offer benefits as an alternative treatment strategy for wide #0-#14 Tessier craniofacial clefts.
1) Characterize relapse after hypertelorbitism correction in #0-#14 craniofacial cleft cases.
2) Test if gradual orbital contraction is an option for wide #0-#14 craniofacial cleft correction.
Methods: Part I: Patients with hypertelorbitism and #0-#14 midline frontonaso-orbital clefts who underwent correction with either a facial bipartition or an orbital box osteotomy were studied (n=18). Bony intraorbital (intradacyron) distances were measured by preoperative, postoperative and follow-up CT scans, as well as, intraoperative direct caliper measurements. Intercanthal measurements were also performed. Comparison of patients aged 5 years or younger was compared to patients older than 5 years of age. An orbital relapse index was calculated based on the postoperative variation of IOD divided by a normal variation of IOD according to the patient’s age at the operation. Part II: A rare case of a wide #0-#14 craniofacial cleft with intradacyron distance of 81mm underwent facial bipartition with gradual orbital contraction and was evaluated.
Results: Part I: Patients were assessed at skeletal maturity after completion of orbital growth. Mean follow-up was 14.3 years of age. The mean intradacyron distance preoperatively was 41 mm (range 33-74mm). Mean intraorbital reduction was 17.5mm. Patients 5 years of age or younger had a higher relapse rate of 51% compared to patients older than 5 years of age with a relapse rate of 16%. In addition, there was a correlation to the severity of hypertelorbitism to the relapse rate with 32% relapse for the more severe cases of hypertelorbitism. Part II: Patient with severe orbital dystopia (81mm intradacyron distance), laterally oriented orbits and anteriorly displaced frontal lobes underwent gradual orbital contraction over 14 days following facial bipartition and removal of abnormal medial bony interferences. Postcontraction intradacyron distance was 21mm. Stage soft tissue correction was performed.
Conclusions: 1) Relapse of hypertelorbitism in #0-#14 cleft patients was related to age of corrective procedure and distance of correction.
2) Gradual orbital contraction is an alternative treatment strategy for wide #0-#14 craniofacial cleft cases.