NASAL CORRECTION IN BINDERS-SYNDROME - THE EVOLUTION OF A TREATMENT PLAN

Maxillofacial dysplasia, or Binder's Syndrome is a challenge for the s urgeon. The evolution of a surgical treatment plan has led to improved facial contour and patient self-image. We studied 27 patients with ma xillonasal dysplasia of variable degrees, both on a short-and long-ter m basis. In some patients, surgical treatment began as early as 3 year s of age, while others were treated as teenagers or young adults. Surg ical options included cartilaginous onlay grafts to the pyriform area, nasal dorsal grafts (linear or L-strut in design), and columellar str ut grafts. Le Fort osteotomies were reserved for those patients with C lass 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 shoul d begin early. This leads to improved self-image by the child's presch ool years, taking advantage from their youthful skin elasticity. In th e young patient, sequential lengthening procedures of the dorsum and c olumella are beneficial. Paranasal and midfacial augmentation is reser ved until midfacial growth is near complete when the patient is in the ir midteenage years.