Abstract
Maxillonasal dysplasia, commonly known as Binder’s syndrome, is unmistakably characterized by midfacial hypoplasia and a retruded flat nose. The condition is variably expressed, and reconstruction must be tailored to the individual. Controversy still exists over the optimal age for surgery and the ideal treatment strategy. In a review of 24 patients with Binder’s syndrome treated at the Chang Gung Craniofacial Centre over a period of 17 years, the authors examine the evolution of their experience treating patients with this condition. Maxillary osteotomies were rarely required and were reserved only for patients with severe and symptomatic class 3 malocclusion. Effective augmentation of the skeletal deficiencies in the midface was achieved with onlay bone or cartilage grafts. Nasal augmentation was performed with bone or cartilage grafts to the dorsum, columella, and tip. Cartilage is preferred over bone as graft material because it retains its volume and is less prone to resorption. Silastic implants can be a useful adjunct to cartilage in cases for which donor availability is limited. To minimize the risk of infection and extrusion, however, silastic implants are always limited to the nasal dorsum and always used in conjunction with cartilage grafts to the columella and tip. The authors prefer to defer surgery until midfacial growth is nearly complete, when the patient is in his or her mid-teenage years. Earlier surgery is indicated if the condition presents a significant psychological strain to the patient. In such cases, a silastic nasal implant can be used as a temporary corrective measure.
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References
Holmstrom H (1986) Clinical and pathologic features of maxillonasal dysplasia (Binder’s syndrome): significance of the prenasal fossa on etiology. Plast Reconstr Surg 78:559–567
Binder K (1962) Dysotosis maxillo-nasalis, ein arhinencephaler missbildungskomplex. Dtsch Zahnaerztl Z 17:438
Munro IR, Sinclair WJ, Rudd NL (1979) Maxillonasal dysplasia (Binder’s syndrome). Plast Reconstr Surg 63:657–663
Resche F, Tessier P, Delaire J et al (1980) Craniospinal and cervicospinal malformations associated with maxillonasal dysostosis (Binder syndrome). Head Neck Surg 3:123–131
Draf W, Bockmuhl U, Hoffmann B (2003) Nasal correction in maxillonasal dysplasia (Binder’s syndrome): a long term follow-up study. Br J Plast Surg 56:199–204
Ragnell A (1952) A simple method of reconstruction in some cases of dish-face deformity. Plast Reconstr Surg (1946) 10:227–237
Converse JM, Horowitz SL, Valauri AJ et al (1970) The treatment of nasomaxillary hypoplasia: a new pyramidal naso-orbital mazillary osteotomy. Plast Reconstr Surg 45:527–535
Jackson IT, Moos KF, Sharpe DT (1981) Total surgical management of Binder’s syndrome. Ann Plast Surg 7:25–34
Hopkin GB (1963) Hypoplasia of the middle third of the face associated with congenital absence of the anterior nasal spine, depression of the nasal bones, and angle class III malocclusion. Br J Plast Surg 16:146–153
Tessier P (1981) Aesthetic aspects of bone grafting to the face. Clin Plast Surg 8:279–301
Holmstrom H (1986) Surgical correction of the nose and midface in maxillonasal dysplasia (Binder’s syndrome). Plast Reconstr Surg 78:568–580
Losken HW, Morris WM (1988) Skull bone grafts in the treatment of maxillonasal dysostosis (Binder’s syndrome). S Afr J Surg 26:90–94
Rune B, Aberg M (1998) Bone grafts to the nose in Binder’s syndrome (maxillonasal dysplasia): a follow-up of eleven patients with the use of profile roentgenograms. Plast Reconstr Surg 101:297–304 (discussion 305–296)
Monasterio FO, Molina F, McClintock JS (1997) Nasal correction in Binder’s syndrome: the evolution of a treatment plan. Aesthetic Plast Surg 21:299–308
Horswell BB, Holmes AD, Barnett JS et al (1987) Maxillonasal dysplasia (Binder’s syndrome): a critical review and case study. J Oral Maxillofac Surg 45:114–122
Banks P, Tanner B (1993) The mask rhinoplasty: a technique for the treatment of Binder’s syndrome and related disorders. Plast Reconstr Surg 92:1038–1044
Gunter JP, Clark CP, Friedman RM (1997) Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 100:161–169
Watanabe T, Matsuo K (1996) Augmentation with cartilage grafts around the pyriform aperture to improve the midface and profile in Binder’s syndrome. Ann Plast Surg 36:206–211
Tham C, Lai YL, Weng CJ et al (2005) Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg 54:1–5 (discussion 6–7)
Ahn J, Honrado C, Horn C (2004) Combined silicone and cartilage implants: augmentation rhinoplasty in Asian patients. Arch Facial Plast Surg 6:120–123
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Goh, R.C.W., Chen, YR. Surgical Management of Binder’s Syndrome: Lessons Learned. Aesth Plast Surg 34, 722–730 (2010). https://doi.org/10.1007/s00266-010-9533-7
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DOI: https://doi.org/10.1007/s00266-010-9533-7