Surgical Management of Binder’s Syndrome: Lessons Learned

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.

Craniofacial Syndromes

“…[152][153][154] Augmentation of the premaxillary and piriform areas can also be achieved with onlay bone grafting. 151 Timing of nasal reconstruction in Binder syndrome patients has also been controversial. The indications for early childhood nasal reconstruction most commonly include pressure from the parents and peers.…”

“…Treatment can involve nasomaxillary augmentation and nasal reconstruction or traditional orthognathic surgery. 151,152 Traditional orthognathic surgery includes orthodontic treatment, with extraction of the maxillary bicuspids and retrusion of the incisors as indicated. A Le Fort I osteotomy can then be performed to provide for greater piriform volume.…”

A Novel Single-Rib Recombination Method in Binder Syndrome Treatment

“…16 Monasterio et al 17 suggested that early surgery with repeated augmentation every few years may help to progressively expand the soft tissue envelope covering the nose and the lining of the nasal cavities, duplicating a pattern similar to normal growth. Goh and Chen 15 proposed that, should the deformity cause psychological distress before patients reach appropriate age for surgery, silicon implantation can act as an effective temporary method of nasal lengthening and stretching of the soft tissue covering while also preserving the availability of autologous donor sites for future use. Ahn et al 18 suggested combined silicone and cartilage implant rhinoplasty.…”

Quantitation of nasal development in the early prenatal period using geometric morphometrics and MRI: a new insight into the critical period of Binder phenotype

“…The nasal septum plays an important role in nasal protrusion, and disturbance of the development of the nasal septum in the early prenatal period causes severe deformity of the nose, called flat nose, which is one of the main characteristics of Binder phenotype . Treatment strategies for such deformity have not been established from the point of view of long‐term favorable esthetic outcomes . To improve treatment strategies for facial deformity, embryonic research for elucidating the development of the nasal septum is inevitable.…”

“…1,2 Treatment strategies for such deformity have not been established from the point of view of long-term favorable esthetic outcomes. [3][4][5] To improve treatment strategies for facial deformity, embryonic research for elucidating the development of the nasal septum is inevitable.…”