The Role of Navigation and Ultrasound Piezosurgery in the Surgical Treatment of Hypertelorism: A Case Report

Background: The surgical treatment of orbital hypertelorism was described by P. Tessier in the late 1960s. Since then, the development of computer-assisted surgical technology has increased our accuracy when planning and performing surgical osteotomies in complex craniofacial deformities. Also, ultrasound piezosurgery may be considered as a minimally invasive technique that allows performing safe osteotomies decreasing the damage of surrounding soft tissues. Patients/material and Methods: We present the clinical case of a 10-year-old girl with a paramedian facial cleft (Tessier 2-12) and a grade III orbital hypertelorism. Surgical planning was done with the iPlan (BrainLab, Munich, Bavaria, Germany) planning software: box osteotomies were designed preoperatively to predict the final intercanthal width and to prevent damage to the maxillary tooth buds. Intraoperative navigation helped to check the adequate position of the osteotomies, which were performed using the Synthes Piezoelectric System (DePuy Synthes, Florida, United States). Results: Good results with no intraoperative complications and a narrower intercanthal width were achieved. A transient postoperative cerebrospinal fluid (CSF) leak was managed with a lumbar drainage. Conclusions: An adequate preoperative planning of the orbital box osteotomies, which can also be checked during the surgery, makes our results more predictable. Orbital osteotomies can be done quickly using the ultrasound piezosurgery, avoiding the risks associated with high-speed tools.