{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:36:29Z","timestamp":1781242589762,"version":"3.54.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Craniofacial clefts, characterized by congenital disruptions in the development of facial and cranial tissues, often present alongside orbital hypertelorism (ORH), an abnormal increase in the interorbital distance. These conditions pose significant challenges in craniofacial surgery due to the complex anatomical and functional considerations involved. This single-center cohort study retrospectively analyzed 22 patients diagnosed with craniofacial cleft syndromes and ORH who were treated at the Craniofacial Centre, Fatima Plastic and Reconstructive Surgery Hospital between July 2016 and October 2023.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This study outlines the preoperative evaluations, surgical interventions, and postoperative outcomes of these cases. Surgical techniques varied according to the severity and type of deformity, guided by Tessier\u2019s classification system. Procedures included spectacle osteotomy, box osteotomy, and facial bipartition osteotomy, with each approach tailored to address the unique anatomical challenges presented by ORH and associated craniofacial anomalies.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n There was a 9% incidence of postoperative infections and a 22.7% incidence of CSF leakage, with a subset of these leading to meningitis. These complications underscore the complexity of managing craniofacial clefts and ORH, highlighting the necessity for meticulous surgical planning and postoperative care.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Despite the challenges, the study demonstrates that individualized, protocol-driven surgical interventions can achieve significant aesthetic and functional improvements in patients with these congenital anomalies.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.10.focus24573","type":"journal-article","created":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T01:13:00Z","timestamp":1735693980000},"page":"E4","source":"Crossref","is-referenced-by-count":3,"title":["Surgical treatment of craniofacial cleft and orbital hypertelorism: a single-center cohort study"],"prefix":"10.3171","volume":"58","author":[{"given":"Kamran","family":"As\u2019adi","sequence":"first","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayedali","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan","family":"Mirsalehi","sequence":"additional","affiliation":[{"name":"ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Plast Reconstr Aesthet Surg","first-page":"676","article-title":"Management of median and paramedian craniofacial clefts","volume":"72","author":"R\u00fcegg EM","year":"2019","unstructured":"R\u00fcegg EM, Bartoli A, Rilliet B, Scolozzi P, Montandon D, Pittet-Cu\u00e9nod B. Management of median and paramedian craniofacial clefts. J Plast Reconstr Aesthet Surg. 2019;72(4):676\u2013684."},{"issue":"4","key":"b2","series-title":"Facial Plast Surg Clin North Am","first-page":"545","article-title":"Tessier clefts and hypertelorism","volume":"24","author":"Winters R","year":"2016","unstructured":"Winters R. Tessier clefts and hypertelorism. Facial Plast Surg Clin North Am. 2016;24(4):545\u2013558."},{"issue":"2","key":"b3","series-title":"Clin Plast Surg","first-page":"185","article-title":"State-of-the-art hypertelorism management","volume":"46","author":"Shakir S","year":"2019","unstructured":"Shakir S, Hoppe IC, Taylor JA. State-of-the-art hypertelorism management. Clin Plast Surg. 2019;46(2):185\u2013195."},{"issue":"1","key":"b4","series-title":"Pol Przegl Chir","first-page":"29","article-title":"Frequency of various craniofacial clefts observed in a single center during a period of 34 years","volume":"92","author":"Fija\u0142kowska M","year":"2019","unstructured":"Fija\u0142kowska M, Antoszewski B. Frequency of various craniofacial clefts observed in a single center during a period of 34 years. Pol Przegl Chir. 2019;92(1):29\u201333."},{"issue":"2","key":"b5","series-title":"J Maxillofac Surg","first-page":"69","article-title":"Anatomical classification of facial, cranio-facial and latero-facial clefts","volume":"4","author":"Tessier P","year":"1976","unstructured":"Tessier P. Anatomical classification of facial, cranio-facial and latero-facial clefts. J Maxillofac Surg. 1976;4(2):69\u201392."},{"issue":"6","key":"b6","series-title":"Plast Reconstr Surg","first-page":"1118","article-title":"Monobloc and facial bipartition osteotomies for reconstruction of craniofacial malformations: a study of extradural dead space and morbidity","volume":"97","author":"Posnick JC","year":"1996","unstructured":"Posnick JC, al-Qattan MM, Armstrong D. Monobloc and facial bipartition osteotomies for reconstruction of craniofacial malformations: a study of extradural dead space and morbidity. Plast Reconstr Surg. 1996;97(6):1118\u20131128."},{"issue":"5","key":"b7","series-title":"Neurochirurgie","first-page":"286","article-title":"Addressing hypertelorism: Indications and techniques","volume":"65","author":"Laure B","year":"2019","unstructured":"Laure B, Batut C, Benouhagrem A, Addressing hypertelorism: Indications and techniques. Neurochirurgie. 2019;65(5):286\u2013294."},{"issue":"4","key":"b8","series-title":"J Craniofac Surg","first-page":"355","article-title":"Rare craniofacial anomaly: Tessier no. 2 cleft","volume":"12","author":"Ozek C","year":"2001","unstructured":"Ozek C, Gundogan H, Bilkay U. Rare craniofacial anomaly: Tessier no. 2 cleft. J Craniofac Surg. 2001;12(4):355\u2013361."},{"issue":"1","key":"b9","series-title":"Scand J Plast Reconstr Surg","first-page":"39","article-title":"Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies","volume":"7","author":"Tessier P","year":"1973","unstructured":"Tessier P, Guiot G, Derome P. Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies. Scand J Plast Reconstr Surg. 1973;7(1):39\u201358."},{"issue":"3","key":"b10","series-title":"Plast Reconstr Surg","first-page":"713","article-title":"Hypertelorism correction: what happens with growth? Evaluation of a series of 95 surgical cases","volume":"129","author":"Marchac D","year":"2012","unstructured":"Marchac D, Sati S, Renier D, Deschamps-Braly J, Marchac A. Hypertelorism correction: what happens with growth? Evaluation of a series of 95 surgical cases. Plast Reconstr Surg. 2012;129(3):713\u2013727."},{"issue":"1","key":"b11","series-title":"J Craniofac Surg","first-page":"217","article-title":"Refinement of the correction of orbital hypertelorism","volume":"22","author":"Liu DL","year":"2011","unstructured":"Liu DL, Shan L, Yuan Q, Huang JJ. Refinement of the correction of orbital hypertelorism. J Craniofac Surg. 2011;22(1):217\u2013219."},{"issue":"1","key":"b12","series-title":"Plast Reconstr Surg (1946).","first-page":"1","article-title":"The surgical treatment of the bifid nose","volume":"6","author":"Webster JP","year":"1950","unstructured":"Webster JP, Deming EG. The surgical treatment of the bifid nose. Plast Reconstr Surg (1946).1950;6(1):1\u201337."},{"issue":"1","key":"b13","series-title":"Plast Reconstr Surg","first-page":"1","article-title":"Ocular hypertelorism and pseudohypertelorism. Advances in surgical treatment","volume":"45","author":"Converse JM","year":"1970","unstructured":"Converse JM, Ransohoff J, Mathews ES, Smith B, Molenaar A. Ocular hypertelorism and pseudohypertelorism. Advances in surgical treatment. Plast Reconstr Surg. 1970;45(1):1\u201313."},{"key":"b14","series-title":"Fortschr Kiefer Gesichtschir","first-page":"68","article-title":"Osteotomies in the middle face and front areas for contour improvement. 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J Craniofac Surg. 2021;32(1):317\u2013319."},{"issue":"4","key":"b19","series-title":"Br J Plast Surg","first-page":"339","article-title":"Medial faciotomy","volume":"32","author":"van der Meulen JC","year":"1979","unstructured":"van der Meulen JC. Medial faciotomy. Br J Plast Surg. 1979;32(4):339-342."},{"issue":"6","key":"b20","series-title":"J Craniofac Surg","first-page":"1859","article-title":"Controversy on the age of hypertelorism correction","volume":"30","author":"Medra AM","year":"2019","unstructured":"Medra AM, Hassanein AG, Fadle KN. Controversy on the age of hypertelorism correction. J Craniofac Surg. 2019;30(6):1859\u20131865."},{"issue":"2","key":"b21","series-title":"J Craniofac Surg","first-page":"385","article-title":"Postoperative complications of box-shift osteotomy for orbital hypertelorism","volume":"31","author":"Jiang T","year":"2020","unstructured":"Jiang T, Yu Z, Chi TY. Postoperative complications of box-shift osteotomy for orbital hypertelorism. J Craniofac Surg. 2020;31(2):385\u2013388."},{"issue":"4","key":"b1","series-title":"J Plast Reconstr Aesthet Surg","first-page":"676","article-title":"Management of median and paramedian craniofacial clefts","volume":"72","author":"R\u00fcegg EM","year":"2019","unstructured":"R\u00fcegg EM, Bartoli A, Rilliet B, Scolozzi P, Montandon D, Pittet-Cu\u00e9nod B. Management of median and paramedian craniofacial clefts. J Plast Reconstr Aesthet Surg. 2019;72(4):676\u2013684."},{"issue":"4","key":"b2","series-title":"Facial Plast Surg Clin North Am","first-page":"545","article-title":"Tessier clefts and hypertelorism","volume":"24","author":"Winters R","year":"2016","unstructured":"Winters R. Tessier clefts and hypertelorism. 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Pol Przegl Chir. 2019;92(1):29\u201333."},{"issue":"2","key":"b5","series-title":"J Maxillofac Surg","first-page":"69","article-title":"Anatomical classification of facial, cranio-facial and latero-facial clefts","volume":"4","author":"Tessier P","year":"1976","unstructured":"Tessier P. Anatomical classification of facial, cranio-facial and latero-facial clefts. J Maxillofac Surg. 1976;4(2):69\u201392."},{"issue":"6","key":"b6","series-title":"Plast Reconstr Surg","first-page":"1118","article-title":"Monobloc and facial bipartition osteotomies for reconstruction of craniofacial malformations: a study of extradural dead space and morbidity","volume":"97","author":"Posnick JC","year":"1996","unstructured":"Posnick JC, al-Qattan MM, Armstrong D. Monobloc and facial bipartition osteotomies for reconstruction of craniofacial malformations: a study of extradural dead space and morbidity. Plast Reconstr Surg. 1996;97(6):1118\u20131128."},{"issue":"5","key":"b7","series-title":"Neurochirurgie","first-page":"286","article-title":"Addressing hypertelorism: Indications and techniques","volume":"65","author":"Laure B","year":"2019","unstructured":"Laure B, Batut C, Benouhagrem A, Addressing hypertelorism: Indications and techniques. Neurochirurgie. 2019;65(5):286\u2013294."},{"issue":"4","key":"b8","series-title":"J Craniofac Surg","first-page":"355","article-title":"Rare craniofacial anomaly: Tessier no. 2 cleft","volume":"12","author":"Ozek C","year":"2001","unstructured":"Ozek C, Gundogan H, Bilkay U. Rare craniofacial anomaly: Tessier no. 2 cleft. J Craniofac Surg. 2001;12(4):355\u2013361."},{"issue":"1","key":"b9","series-title":"Scand J Plast Reconstr Surg","first-page":"39","article-title":"Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies","volume":"7","author":"Tessier P","year":"1973","unstructured":"Tessier P, Guiot G, Derome P. Orbital hypertelorism. II. Definite treatment of orbital hypertelorism (OR.H.) by craniofacial or by extracranial osteotomies. Scand J Plast Reconstr Surg. 1973;7(1):39\u201358."},{"issue":"3","key":"b10","series-title":"Plast Reconstr Surg","first-page":"713","article-title":"Hypertelorism correction: what happens with growth? Evaluation of a series of 95 surgical cases","volume":"129","author":"Marchac D","year":"2012","unstructured":"Marchac D, Sati S, Renier D, Deschamps-Braly J, Marchac A. Hypertelorism correction: what happens with growth? Evaluation of a series of 95 surgical cases. Plast Reconstr Surg. 2012;129(3):713\u2013727."},{"issue":"1","key":"b11","series-title":"J Craniofac Surg","first-page":"217","article-title":"Refinement of the correction of orbital hypertelorism","volume":"22","author":"Liu DL","year":"2011","unstructured":"Liu DL, Shan L, Yuan Q, Huang JJ. Refinement of the correction of orbital hypertelorism. J Craniofac Surg. 2011;22(1):217\u2013219."},{"issue":"1","key":"b12","series-title":"Plast Reconstr Surg (1946).","first-page":"1","article-title":"The surgical treatment of the bifid nose","volume":"6","author":"Webster JP","year":"1950","unstructured":"Webster JP, Deming EG. The surgical treatment of the bifid nose. Plast Reconstr Surg (1946).1950;6(1):1\u201337."},{"issue":"1","key":"b13","series-title":"Plast Reconstr Surg","first-page":"1","article-title":"Ocular hypertelorism and pseudohypertelorism. 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Neurosurg Focus. 2014;36(4):E17."},{"issue":"11","key":"b16","series-title":"J Craniomaxillofac Surg","first-page":"1712","article-title":"Surgical treatment of orbital hypertelorism: historical evolution and development prospects","volume":"47","author":"Batut C","year":"2019","unstructured":"Batut C, Joly A, Travers N, Guichard B, Par\u00e9 A, Laure B. Surgical treatment of orbital hypertelorism: historical evolution and development prospects. J Craniomaxillofac Surg. 2019;47(11):1712\u20131719."},{"key":"b17","series-title":"Surg Neurol Int","first-page":"145","article-title":"Isolated hypertelorism: late surgical correction using the box osteotomy technique","volume":"15","author":"de Sousa BC","year":"2024","unstructured":"de Sousa BC, Ferreira-Pinto PHC, Ferreira DBCO. Isolated hypertelorism: late surgical correction using the box osteotomy technique. Surg Neurol Int. 2024;15:145."},{"issue":"1","key":"b18","series-title":"J Craniofac Surg","first-page":"317","article-title":"Orbital hypertelorism correction with inverted-U osteotomy: indications and advantages","volume":"32","author":"Huang Q","year":"2021","unstructured":"Huang Q, Yang B, Li B, Ma H. Orbital hypertelorism correction with inverted-U osteotomy: indications and advantages. J Craniofac Surg. 2021;32(1):317\u2013319."},{"issue":"4","key":"b19","series-title":"Br J Plast Surg","first-page":"339","article-title":"Medial faciotomy","volume":"32","author":"van der Meulen JC","year":"1979","unstructured":"van der Meulen JC. Medial faciotomy. Br J Plast Surg. 1979;32(4):339-342."},{"issue":"6","key":"b20","series-title":"J Craniofac Surg","first-page":"1859","article-title":"Controversy on the age of hypertelorism correction","volume":"30","author":"Medra AM","year":"2019","unstructured":"Medra AM, Hassanein AG, Fadle KN. Controversy on the age of hypertelorism correction. 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