Nasomaxillary Reconstruction in Binder Syndrome

Abstract

Maxillonasal dysplasia is characterized by a concave facial profile and a flat nose. The etiology of Binder syndrome is skeletal hypoplasia around the piriform aperture and excavations-fossae prenasales, bilaterally in the nasal floor-which are pathognomonic. There is no real shortage of the soft tissues. In 2 medical centers in Sweden and Mexico, different grafts were used for reconstruction, but the focus was similar, filling out the maxilla anterior to the nasal floor and supporting the nasal framework to normalize tip projection. The basis for this study was to compare the long-term results between bone grafts in Sweden and cartilage grafts in Mexico. Sixteen patients from both groups were available for long-term follow-up. Simplified digital analysis of anthropometric variables were performed in the short-term and long-term follow-ups. The Swedish group had primary at the mean age of 21.3 years, whereas mean follow-up period was 16.8 years later. The Mexican group had primary at the age of 13.6 years, and the follow-up period was 8.4 years. Secondary correction was necessary in 25% of the patients in the bone graft group (Sweden) and in 19% of patients in the cartilage group (Mexico). Bone grafts slightly relapsed in tip projection and remodeled to some extent in the nasolabial angle. Cartilage grafts showed stability in the tip projection quotients and resulted in a postoperative normalization of the nasolabial angle but developed a slight relapse between the short-term and long-term follow-ups. Both techniques were stable in nose tip-length ratio, and a normalization of anthropometric variables was demonstrated in all the long-term follow-ups. Both the bone and cartilage graft techniques at the 2 centers rendered the intended result of an increased and normalized angle of convexity of the face and nasal tip projection. An experience in the properties and behavior of either graft is necessary to get a long-term stable outcome.