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

ABSTRACT

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.