Widening Inter-Canthal Distance with Orbital Box Osteotomies: A Cosmetic Application

Goals/Purpose: Orbital re-positioning procedures have been utilized in order to correct orbital hypertelorism and other orbital anomalies, such as vertical orbital dystopia, neurofibromatosis-associated growths, and cranio-orbital lesions. Cosmetic applications of such techniques, however, have rarely been explored. The purpose of this study is two-fold: 1) to perform a systematic review of use of orbital osteotomies in craniofacial surgery, and to 2) present a case study and video vignette of the senior author’s cosmetic application of orbital box osteotomies to widen the intercanthal distance in a 31-year-old male.

Methods/Technique: A systematic literature review was performed in order to survey articles that discussed applications of orbital box osteotomies within craniofacial surgery. A patient receiving the operation for cosmetic purposes was additionally included as a case report for analysis. Video footage was collected for comprehensive discussion of the techinque. 3D-planning was utilized using computed tomogram and VSP (3D Systems, Rock Hill, SC). Custom plates were utilized in order to achieve the desired intercanthal distance.

Results/Complications: Initial review of the literature yielded 38 articles. After application of exclusion criteria, a total of eleven articles were included for analysis. Orbital box osteotomies were utilized in indications, including craniosynostosis, craniofacial clefts, cranio-orbital lesions, vertical orbital hyperplasia, cranium bifidum occultum, craniofrontonasal dysplasia, facial feminization surgery, and neurofibromatosis. No articles discussed cosmetic application of orbital box osteotomies. Our patient successfully underwent orbital box osteotomies with favorable aesthetic results. Pre and post-operative photographs, as video footage, were obtained.

Conclusion: s: This video vignette demonstrates the senior author’s use of orbital box osteotomies to manipulate the patient’s intercanthal distance while achieving favorable aesthetic results. Future studies should explore the utility of orbital re-positioning procedures for aesthetic purposes, and how adjunct procedures (i.e., rhinoplasty and orthognathic surgery), may be used in combination to refine the overall facial appearance.