J Korean Assoc Oral Maxillofac Surg.  2020 Dec;46(6):379-384. 10.5125/jkaoms.2020.46.6.379.

Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction

• Lee JY
• Choung HW
• Choung PH

• KMID: 2510007
• DOI: http://doi.org/10.5125/jkaoms.2020.46.6.379

Abstract

Objectives
We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans.
Patients and Methods
In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III.
Results
Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side.
Conclusion
The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient’s skeletal and soft-tissue discrepancies.

Keyword

Orbit; Facial asymmetry; Anthropometry

Figure

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  Fig. 1 Analysis of skeletal vertical discrepancy using the differences in the levels of orbits. A horizontal line (white line) from midpupil perpendicular to the midline of the face (black line) was drawn, and the differences between the horizontal lines from each side of the eyes were calculated.

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  Fig. 2 Analysis of soft tissue discrepancy using the differences in the levels of medial canthi. A horizontal line (white line) from medial canthus perpendicular to the midline of the face (black line) was drawn, and the differences between the horizontal lines from each side of the eyes were calculated.

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  Fig. 3 Analysis of soft tissue discrepancy using the differences in the levels of lateral canthi. A horizontal line (white line) from lateral canthus perpendicular to the midline of the face (black line) was drawn, and the differences between the horizontal lines from each side of the eyes were calculated.

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  Fig. 4 Measurement of canthal tilt using an angle formed by a line connecting the medial canthus and lateral canthus (red line) and a perpendicular line (white line) connecting the medial canthus and the midline of the face (black line).

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  Fig. 5 Classification of canthal tilt. Criteria for classifying the various canthal tilts was applied. Class I, canthal tilt between 0° and 5°; Class II, canthal tilt over 5°; Class III, canthal tilt less than 0°.

Reference

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