ASSESSMENT AND TREATMENT OF FACIAL DEFORMITY RESULTING FROM RADIATIONTO THE ORBITAL AREA IN CHILDHOOD

Children who receive radiation for malignant tumors in the orbital are a frequently develop widespread craniofacial deformities. These affect the skull, orbit, maxilla, and mandible. When these patients seek tre atment at a later age, they require careful assessment using cephalome trics and three-dimensional imaging. It is recommended that the four l evels of skeletal deformity be corrected in a single procedure, that i s frontotemporal expansion with repositioning of the skull base area, orbital expansion and repositioning together with maxillary and mandib ular surgery. Bone grafts should be inlay rather than onlay and soft t issue should be supplied by free-tissue transfer. This counteracts any residual ischemia related to the previous radiation therapy. The seco nd surgical stage is designed to reconstruct the socket and the eyelid s to allow more satisfactory rehabilitation with an ocular prosthesis. In patients who have a globe present, the usual enophthalmos can be c orrected by repositioning of the eye as part of the first procedure by reducing the anteroposterior dimensions of the socket. In bilateral c ases, the deformity is hourglass in nature and requires correction in the frontal and temporal area with lateral displacement of the orbits. a bimaxillary procedure is also indicated. It is emphasized that to f ormulate a satisfactory operative plan an in-depth three-dimensional a nalysis of the deformity is mandatory.