Orbital dystopia is a malposition of the ocular globe and orbit due to a mono or bilateral asymmetry and distortion of the bony structure.
Orbital dystopia may occur in different situations. Commonly it is due to craniofacial injury with downward displacement of the superior orbital margin and orbital roof or infero-laterally with associated naso-ethmoidal injuries. If early correction has not been achieved, osteotomies via a coronal flap approach may be required.
Surgical correction includes restoration of the orbital cavity with proper volume, shape and relationships to adjacent structures. Replacement of malpositioned original orbital bones,increasing with autogenous split cranium, or iliac grafts are often necessary.
An abnormal position of the medial or lateral canthi is frequent also. Downward dislocation of the lateral canthus is seen in abnormalities involving the nasomaxillary skeleton. Downward dislocation of the lateral canthus is observed in malar hypoplasia (Treacher Collins’ Syndrome) and in different syndromes with craniofacial dysostosis (antimongoloid slanting).
Upward dislocation of the lateral canthus is seen in sphenofrontal dysplasia or in plagiocephaly. Right orbital dystopia with exophthalmos due to orbital roof “blow in” fracture. The orbital roof was repositioned and recontructed via trans-cranial route with repositioning of the orbital content, medial canthopexi.
(case operated in collaboration with prof. C. Curioni)