ABSTRACT
By definition, orbital dystopia is any type of abnormal displacement of the entire orbital cones
and their contents that can occur in three different dimensional planes. Orbital dystopia in
horizontal and vertical planes have been given the terminology orbital hypertelorism and
vertical orbital dystopia (1,2). In defining orbital hypertelorbitism, Tessier (the father of
craniofacial surgery) stressed the displacement of the entire orbital cones. The severity of the
hypertelorism was based on the measurements of the intercantal distance and shape of frontal-
orbital region (1). Following Tessier’s principles, vertical orbital dystopia was defined as an
abnormal displacement of the entire orbital cones in the vertical plane, not just displacement of
one, two, or three orbital segments. Both orbital hypertelorism and vertical orbital dystopia
initially referred to congenital conditions, but later were used to describe facial
trauma, muscular torticollis, facial skeletal tumors, and iatrogenic and idiopatic causes (3).
Nevertheless, it is extremely important to emphasize that the acute displacement of the orbital
walls does not necessarily accompany the displacement of the orbital rims and should not be
referred to as orbital hypertelorism or vertical orbital dystopia. In this line of thinking, facial
trauma with a low impact force does not lead to orbital dystopia, mainly because there is not
enough energy to provoke mobilization of the entire orbital cone. Therefore, it is our belief that,
other than congenital and tumoral causes, only facial trauma with very high energy may cause
displacement of the entire orbital cones.
