Modified nasomaxillary and hard palatine osteotomy combined nasal implantation to correct Binder syndrome

Maxillonasal dysplasia, or Binder syndrome, is a congenital condition consisting of midfacial hypoplasia with a characteristic of flat nasal deformity. Overall goal of treatment is to advance skeletal dysplasia of the midface and correct the deformities of the flat nose. Surgical approach is mainly varied with the degree of deformity from simple nasal implant to complicated naso-maxillary osteotomy. In our study, we reported 8 patients with maxillonasal dysplasia using modified naso-maxillary complex and hard palatine "box" osteotomy, combined with chondrocostal bone grafts or nasal implant to correct the retruded nasal deformity. The technique has been used in all patients with ages and degree of deformity. All patients were satisfied with outcome of operation, no severe complication was found. Six-month follow-up evaluation showed good correction of the midface profile and nasal projection, the advancement of midface was found stable, chondrocostal bone graft was fixed perfectly, and no obvious absorption and remodeling was found in short time. The lateral cephalometric analysis and superimposition results showed after the operation, sella-nasion distance had been increased approximately 5 mm, and SNA angle had been increased about 10 degrees. Soft tissue measurement showed the facial convexity angle has increased 8 degrees; the nasolabial angle had increased about 10 degrees after surgery. The tip of the nose had moved 10.0 mm anteriorly and 3.0 mm coronally, respectively. As the result showed modified nasomaxillary complex and hard palatine "box" osteotomy can be a good alternative for advancement of midfacial hypoplasia instead of traditional Le Fort I, II osteotomy, chondrocostal bone graft is a perfect option to correct nasal deformity of Binder syndrome, and both can satisfy requirement of patients.