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Customized guided box osteotomies in pediatric patients with orbital hypertelorism

Orbital hypertelorism is a rare and surgically demanding craniofacial anomaly requiring highly accurate three-dimensional repositioning of the orbital complexes. This retrospective case series reports the use of virtual surgical planning with patient-specific cutting guides for orbital box osteotomy...

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Main Authors: Bigus, Simon (Author) , Koerdt, Steffen (Author) , Schulz, Matthias (Author) , Elter, Tim Lukas (Author) , Bestendonk, Carolin (Author) , Schwaiger, Michael (Author) , Kaiser, Paul Frederic (Author) , Thomale, Ulrich-Wilhelm (Author) , Heiland, Max (Author) , Ebker, Tobias (Author)
Format: Article (Journal)
Language:English
Published: July 2026
In: Journal of cranio-maxillofacial surgery
Year: 2026, Volume: 54, Issue: 7, Pages: 1-7
ISSN:1878-4119
DOI:10.1016/j.jcms.2026.104563
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jcms.2026.104563
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S1010518226001204
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Author Notes:Simon Bigus, Steffen Koerdt, Matthias Schulz, Tim Lukas Elter, Carolin Bestendonk, Michael Schwaiger, Paul Frederic Kaiser, Ulrich-Wilhelm Thomale, Max Heiland, Tobias Ebker
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Summary:Orbital hypertelorism is a rare and surgically demanding craniofacial anomaly requiring highly accurate three-dimensional repositioning of the orbital complexes. This retrospective case series reports the use of virtual surgical planning with patient-specific cutting guides for orbital box osteotomy in five pediatric patients (mean age at surgery 5.8 years; range 5-8 years) treated at a tertiary craniofacial center between 2021 and 2024. Osteotomy and ostectomy lines were planned on CT data and transferred intraoperatively using customized fronto-orbital and infraorbital guides, followed by medialization of the orbital boxes, rigid fixation, and medial canthopexy. Mean interorbital distance was reduced from 34.7 ± 2.66 mm to 19.06 ± 2.95 mm (mean reduction 45.3%). Surgical transfer accuracy was high, with a root mean square deviation of 0.40 mm between planned and postoperative dacryon distances. No postoperative infections, intracranial hemorrhages, material failure, or plate displacement occurred; one patient developed new-onset strabismus. Despite substantial bony correction, mild residual pseudo-hypertelorism remained clinically apparent in all patients, highlighting the relevance of soft-tissue limitations. Patient-specific guided workflows enabled precise and reproducible skeletal correction and may support predictability in complex and revision craniofacial procedures.
Item Description:Online verfügbar: 10. April 2026, Artikelversion: 10. April 2026
Gesehen am 26.05.2026
Physical Description:Online Resource
ISSN:1878-4119
DOI:10.1016/j.jcms.2026.104563

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