A simple technique for the correction of maxillonasal dysplasia using customized expanded polytetrafluoroethylene (ePTFE) implants

Abstract

The treatment of maxillonasal dysplasia in Binder's syndrome using autologous costal bone and cartilage is well established, but postoperative results may be compromised by scarring, unpredictable absorption of transferred autologous tissue, and donor site morbidity. Here, we propose a simple surgical technique to improve maxillonasal dysplasia using an expanded polytetrafluoroethylene (ePTFE) implant. From February 1999 to May 2014, fifty-eight patients affected by maxillonasal dysplasia with different degrees of flattened nose and midfacial depression underwent surgical correction by augmentation of the nasal dorsum using an "L"-shaped ePTFE and subperiosteal implantation of an inverted "m"-shaped ePTFE at the base of the piriform aperture. The outcome was evaluated based on preoperative and postoperative patient pictures, 3D imaging technology for the assessment of nasolabial angle and facial convexity angle, and a postoperative patient satisfaction survey. Postoperative results showed improved facial aesthetics with a significantly increased nasolabial angle from initially 74.1°±8.9° to 93.7°±6.1° at 6 months postoperatively (p<0.05). Temporary discomfort involving upper lip numbness, foreign body sensation, and stiff smiling expression were complained during the first 3 months postoperatively, but spontaneously resolved within 6 months. Complications included infection (2 cases), implant migration (2 cases), and implant exposure (1 case). The vast majority of patients (95.7%) rated their postoperative outcome as highly improved and improved. The present therapeutic strategy provides a simple and effective treatment for the correction of maxillonasal dysplasia with high patient acceptance in a single step approach. Further research is required to determine long-term outcomes.