Hypertelorism: The Importance of Three- Dimensional Imaging and Trends in the Surgical Correction by Facial Bipartition Andrea Moreira Gonzalez, M.D., Mohammed Elahi, M.D., Khaled Barakat, M.D., Reha Yavuzer, M.D., Ben Brinkmann, M.D., and Ian T. Jackson M.D. Southfield, Mich.; Ankara, Turkey; and Rochester, Minn. Background: The technique of facial bipartition has been considered a great ad- vance in achieving a more natural appear- ance in hypertelorism correction. Methods: Fourteen patients who had undergone hypertelorism correction by fa- cial bipartition were retrospectively studied to analyze the role of three-dimensional computed tomographic reconstruction in the evaluation of the deformity and preop- erative planning. The procedure and sur- gical details that can improve the outcome were described. A reproducible set of three- dimensional measurements that can help in preoperative patient evaluation was de- termined based on information obtained using the Analyze/AVW 3.1 system (Bio- medical Imaging Resource, Mayo Founda- tion, Rochester, Minn.). Results: In this series, the most com- mon diagnosis was frontonasal dysplasia (64.3 percent). Five patients had second- degree (35.7 percent) and nine had third- degree hypertelorism (64.3 percent). The three-dimensional scans were shown to be highly accurate in predicting the degree of deformity. There was a significant differ- ence in the preoperative and postoperative interdacryon distance and midface height (p  0.05) but not in the bitemporal dis- tance (p = 0.08). The simulation correlated significantly with the postoperative result when interdacryon distance and midface height were analyzed (0.736 and 0.999). Conclusions: Facial bipartition pro- vided a three-dimensional correction of hy- pertelorism. Three-dimensional imaging can definitely be considered an extra tool for accurate surgical planning and helping the family understand the surgical proce- dure and the end result. (Plast. Reconstr. Surg. 115: 1537, 2005.) Facial bipartition has evolved from the first “medial fasciotomy,” performed by van der Meulen, 1 in which the median cleft was excised and the hemifacial segments were rotated me- dially in conjunction with advancement. Since then, this technique had been further refined and applied in hypertelorism correction. 2–7 Assessment and evaluation of complex craniofacial deformities improved after the in- troduction of two-dimensional computed to- mography scans. 8–19 The efficacy of three- dimensional reconstruction has also been reported. Currently, the high-technology ma- chines and new-generation software have im- proved the quality of the three-dimensional images, and these are now the definitive stan- From the Institute for Craniofacial and Reconstructive Surgery; the Department of Plastic and Reconstructive Surgery, Gazi University Medical School; and RTR, Department of Radiology, Mayo Clinic. Received December 23, 2002; revised July 19, 2004. Presented at the 13th Annual Meeting of the North American Skull Base Society, in San Diego, Califiornia, February 16 to 19, 2002, and at the 49th Annual Meeting of the Michigan Chapter of the American College of Surgeons, in Bellaire, Michigan, May 9 to11, 2002. DOI: 10.1097/01.PRS.0000160272.43382.F0 1537