Nasal correction in Binder's syndrome: the evolution of a treatment plan

Maxillofacial dysplasia, or Binder's Syndrome is a challenge for the surgeon. The evolution of a surgical treatment plan has led to improved facial contour and patient self-image. We studied 27 patients with maxillonasal dysplasia of variable degrees, both on a short- and long-term basis. In some patients, surgical treatment began as early as 3 years of age, while others were treated as teenagers or young adults. Surgical options included cartilaginous onlay grafts to the pyriform area, nasal dorsal grafts (linear or L-strut in design), and columellar strut grafts. Le Fort osteotomies were reserved for those patients with Class III malocclusion (15% in this series). The overall goals were to augment skeletal deficiencies of the midface and begin the soft tissue expansion process as early as possible. From our long-term follow-ups (up to 15 years) it has become apparent that surgical treatment should begin early. This leads to improved self-image by the child's preschool years, taking advantage from their youthful skin elasticity. In the young patient, sequential lengthening procedures of the dorsum and columella are beneficial. Paranasal and midfacial augmentation is reserved until midfacial growth is near complete when the patient is in their midteenage years.