A Case of Binder Syndrome: Rhinoplasty Surgeon's Perspective / 대한이비인후과학회지

Binder syndrome, also called the congenital flat nose syndrome, is a rare congenital malformation with a flat facial profile, intermaxillary hypoplasia and malocclusion. Rhinoplasty plays an important part in the multidisciplinary surgical protocol for this syndrome, for which weak nasal framework and soft tissue underdevelopment have been considered a great challenge. We present a case of Binder syndrome of a 27-year-old male. The nose was reconstructed with a caudal septum replacement graft and bilateral extended spreader grafts using costal cartilage.

Effectiveness of autologous costal cartilage transplantation in repair of Binder's syndrome / 中国修复重建外科杂志

Objective: To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder's syndrome. Methods: Between June 2012 and June 2017, 8 cases of Binder's syndrome were admitted. There were 3 males and 5 females, aged 16-31 years (mean, 22 years). All patients were conformed to the typical manifestations of Binder's syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder's syndrome was evaluated. Results: All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in 1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation ( P0.05). Conclusion: Autogenous costal cartilage transplantation in repair of Binder's syndrome can obviously improve patients' appearance of the external nose and middle face, and obtain the persistent effectiveness.

Binder Syndrome Infant Born from Mother with Cholelithiasis / 대한소아내분비학회지

Binder syndrome is a maxillonasal dysostosis characterized by midface and nasal hypoplasia. It is sometimes associated with short terminal phalanges of fingers and toes and transient radiological features of chondrodysplasia punctata. It is associated with vitamin K deficiency during pregnancy. We describe here a baby with Binder syndrome who was born from mother with cholelithiasis during pregnancy.

Reconstructions of Binder's Syndrome with Various Surgical Techniques: Photogrammetric Analysis of Nasomaxillary Bone

Binder's syndrome has some characteristic signs, such as orbital hypotelorism, shortened and flat noses, diminutive columella, crescent shaped nostrils, acute nasolabial angle, convex upper lip, class III malocclusion, absent anterior nasal spine, and maxillary hypoplasia. Binder's syndrome patients usually need the correction of the following three: the hypoplatic nose, the perialar flatness due to underdevelopment of the piriform margin, and the hypoplastic maxilla with its malocclusion. The authors treated eleven(n=14) patients through various surgical techniques depending on the clinical signs. In order to correct the nasomaxillary hypoplasia, the autogenous bones, the autogenous cartilages and the alloplastic implants were used. In three patients with severe nasomaxillary retrusion, the combined Le Fort I and II osteotomies and the perinasal osteotomy were performed. The results were analyzed using the proportion indices from the preoperative and postoperative lateral photographs of the patients. The postoperative values of all the proportion indices were significantly higher compared to the preoperative ones. For nasal dorsal augmentation, columellar lengthening and peripiriform augmentation, autogenous bone grafts were found to be very effective. The use of high-density porous polyethylene sheets for columellar lengthening was preferred over the use of nasal septal cartilages. Two types of osteotomy were the most effective for nasomaxillary augmentation in severe deformity.