Pathologies of the orbital dystopia or orbital deformities include congenital anomalies, trauma and tumors. However, these conditions are rare and surgical planning in detail is always difficult. We herein report our limited experience in the treatment of orbital dystopia/deformity, and discuss pre-surgical planning as well as surgical techniques and post-operative considerations.
　　Materials：In the past 18 years, we treated 26 cases of orbital dystopia/deformity. There were 11 males and 15 females. There were 12 cases of post traumatic deformity comprising 4 cases of malunion of panfacial fractures and 8 cases of malunion of orbital fractures. Of those with congenital anomalies, 4 cases of anterior plagiocephaly, one of Apert syndrome and one of hypertelorism were treated. There were 3 cases of neurofibromatosis type 1 involving the orbital roof, 2 cases of fibrous dysplasia of the orbit, and 3 cases of post-ablative surgery for maxillary cancer.
　　Discussion：In the first step of surgical planning, CT scan, 3DCT and facial landmarks were combined to determine the facial midline. Vertical/horizontal orbital dystopia, orbital dimension and exophthalmos/enophthalmos were then evaluated on the CT image. A 3D model is a useful option for surgical simulation. The occlusal plane, pupil line and nasal bridge line are helpful landmarks, and the facial scale is the most reliable ruler to control bilateral orbits in cases of vertical orbital dystopia. Neurofibromatosis may involve the anterior cranial base connecting the cranial and orbital cavities, resulting in pulsatile proptosis. Surgery was focused on separating the two with titanium mesh, which was pre-bent to fit the bone defect on the 3D model. In the treatment of congenital pathologies, periodical follow-up is crucial as the two orbits may grow independently and lead to further surgery. Soft tissue deformities surrounding the orbit are treated when soft tissue swelling subsides after skeletal surgery. From our limited experience, vertical orbital dystopia was precisely treated as planned in accordance with pre-surgical computer simulations. However, horizontal movement of the orbit was less reflected by the amount of medial eye movement in cases of hypertelorism, which was approximately 70% of the amount of skeletal movement.

　　Orbital dystopia, which is vertical, horizontal or mixed displacement of the orbit, is mainly an aesthetic problem, except when due to trauma or neoplasm, because the patient does not have vision problems. To obtain a morphologically aesthetic outcome, the volume of soft tissue and bone has to be assessed accurately on computed tomography and three-dimensional models to make a proper diagnosis. In addition, accurate and reasonable surgical techniques for aesthetic craniofacial surgery using both intracranial and extracranial approaches are necessary. We herein report our systematic craniofacial approaches to these surgically and aesthetically challenging deformities.

　　Basal cell carcinoma（BCC）develops most commonly on the face. Although non-pigmented BCC is rare among Japanese, it is relatively common among Caucasians. Non-pigmented BCC is difficult to diagnose based solely on clinical findings. Dermatoscopy is a non-invasive and helpful diagnostic tool for pigmented lesions, including BCC. The dermatoscopic features of such lesions, especially the presence of arborizing vessels, are useful for the diagnosis of not only pigmented BCC but also non-pigmented BCC. We herein report four cases of non- or hypo-pigmented BCC. Case 1 was an 82-year-old Japanese woman with a hypo-pigmented nodule on the upper lip, case 2 was a 31-year-old Caucasian man with an ulcer on the upper lip, case 3 was a 40-year-old Japanese man with a non-pigmented nodule on the external nose, and case 4 was a 55-year-old Japanese woman with a non-pigmented nodule on the external nose. Resection was performed for all four cases, and they were histopathologically diagnosed as BCC. All four cases were confirmed to be non-pigmented BCC based on the clinical and histopathological findings.

　　Oncocytoma is a relatively rare tumor that mainly occurs in the salivary glands. Here, we describe an 88-year-old Japanese woman with an oncocytoma in the right parotid gland that developed 6 months before she came to our hospital. Her physical examination revealed a subcutaneous tumor that was approximately 40 mm in diameter. It was elastic, soft and mobile, and had a smooth surface. There were no palpable cervical lymph nodes and no facial nerve paralysis. On computed tomography, we identified a tumor with a relatively clear margin at the lower part of the right parotid gland. However, the patient’s son did not consent to an operation because of her advanced dementia. The tumor gradually enlarged. Therefore, we performed superficial partial parotidectomy. The patient had no postoperative recurrence after 1 year and 4 months. As histopathological examination of the resected tumor revealed the proliferation of oncocytes containing eosinophilic granules, the tumor was confirmed to be an oncocytoma. The possibility of recurrence and malignant transformation has been informed, and surgical removal is common.