Retroposition of the Globe After Le Fort III Midfacial Distraction

Background: Patients with syndromic craniosynostosis exhibit exorbitism due to supraorbital and midfacial retrusion. This study documented the change in sagittal orbital-globe relationship following Le Fort III midfacial advancement. Methods: This retrospective case series comprised patients with syndromic craniosynostosis who underwent midfacial distraction from 1997 to 2016. Changes in sagittal globe position in relation to the orbital rims were measured by pre-and postoperative direct anthropometry, computed tomographic scans, or both methods. Descriptive statistics were calculated; significance was set at P< 0.05. Results: Anthropometry showed a significant increase from superior orbital rim-to-corneal apex (os-acor) (4.1 +/- 4.0 mm, P< 0.001) and from inferior orbital rim-to-corneal apex (oiacor) (4.5 +/- 5.3 mm, P< 0.001). The lateral orbital rim to the corneal apex (ol-acor) dimension did not change significantly. Computed tomography measurements confirmed retropositioned globes relative to the anterior border of the orbital cavity (2.5 +/- 6.4 mm, P = 0.036). The 2 analytic methods yielded statistically similar results. Conclusion: The globes move posteriorly a mean of 2.5 to 4.5mm following Le Fort III midfacial distraction in patients with syndromic craniosynostosis. This finding is useful in attaining euophthalmos when planning and executing this procedure.