Indian Journal of Plastic Surgery
An open access publication of Association of Plastic Surgeons of India
Users Online: 24  
Home | Subscribe | Feedback | Login 
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (60 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  
  In this article
   References

 Article Access Statistics
    Viewed1657    
    Printed71    
    Emailed2    
    PDF Downloaded152    
    Comments [Add]    

Recommend this journal

 


 
INVITED DISCUSSION
Year : 2008  |  Volume : 41  |  Issue : 2  |  Page : 160-161
 

Maxillonasal dysplasia (Binder's syndrome) and its treatment with costal cartilage graft: A follow-up study


Department of Plastic Surgery, LTMG Hospital, Sion, Mumbai, India

Correspondence Address:
Mukund Jagannathan
Department of Plastic Surgery, LTMG Hospital, Sion, Mumbai
India
Login to access the Email id


DOI: 10.4103/0970-0358.44930

PMID: 19753256

Get Permissions



How to cite this article:
Jagannathan M. Maxillonasal dysplasia (Binder's syndrome) and its treatment with costal cartilage graft: A follow-up study. Indian J Plast Surg 2008;41:160-1

How to cite this URL:
Jagannathan M. Maxillonasal dysplasia (Binder's syndrome) and its treatment with costal cartilage graft: A follow-up study. Indian J Plast Surg [serial online] 2008 [cited 2014 Jul 10];41:160-1. Available from: http://www.ijps.org/text.asp?2008/41/2/160/44930


The term nasomaxillary hypoplasia was first used by Converse [1] in 1970, to describe a variety of clinical conditions, which have in common, a significant underdevelopment of the nasomaxillary complex. Henderson and Jackson [2] in 1973 further classified the deformity clinically, based on the involvement of the dentoalveolar segment.

Regarding the nasal pathology, Rintala [3] has described two types of nasal deformities: flattened nose of normal length, and a foreshortened nose. Jackson et al [4] have described the columella and upper lip as being indrawn into the nasal floor, and lack of palpability of the nasal spine and the pyriform fossa.

There are several options for treatment depending on the degree and the severity of the deformity. The various components of the deformity are addressed individually or in combination.

  • Nose:

    Nasal lengthening (skin, cartilage and septum)

    Columellar lengthening

    Dorsal augmentation

    Tip projection


  • Maxillary platform augmentation


  • Inlay grafting


  • Osteotomies


The authors have shown fairly acceptable results in their cases. However, one of the cases was very mild, and did not have typical features of nasomaxillary hypoplasia, but rather more of a depressed nasal dorsum and underprojecting tip ([Figure 8] and [Figure 9]in the article). The more difficult cases ideally needed osteotomies to bring the nose and perinasal area forwards. Without osteotomies, despite onlay grafting, the result will always be compromised. Tip grafting may be additionally needed.

I agree with the authors that one need not wait for skeletal maturity to operate these patients. However, one should warn the patient about the possibility of repeat surgery.

As far as exposure of the nasal framework is concerned, it is not strictly necessary to take an external (in their cases- midcolumellar) incision. It is entirely possible to deglove and skeletonise the nasal framework with a buccal sulcus incision and transfixion incision continuing as an infracartilaginous incision.

When the deformity is severe, bone grafting allows a greater correction of the sunken nose. Bone grafts must be cantilevered, or used as a L shaped structure. This provides mechanical support to maintain the tip in place. Cartilage grafts on the other hand cannot be used as stress bearing structures. They are more spacers, which can allow a mild stretching of tissue.

Another issue is the limitation of the lining of the nose. In cases where the hypoplasia is extreme, the entire nasal lining may have to be released from the maxilla and a post nasal inlay as described by Gillies [5] , may be needed. The patient usually has to wear a permanent prosthesis to maintain the projection. Nasolabial flaps may occasionally be used to resurface the lining. Banks and Tanner [6] have used buccal mucosal flaps to line the defect in the nasal mucosa after release. These manoeuvres will allow the nose to stay in its new position, without too much of a contracting force.

The authors have done an extensive review of the pathology and the rationale for various modes of treatment. However, one solution rarely fits all problems, and while cartilage grafting does take care of a large cross section of cases, it is by no means the only form of treatment.

 
  References Top

1.Converse, J. M., Horowitz, S. L., Valauri, A.J., and Montandon, D.: The treatment of nasomaxillary hypoplasia. A new pyramidal naso-orbitomaxillary osteotomy. Plast. Reconstr. Surg., 45: 527, 1970.  Back to cited text no. 1    
2.Henderson, D., and Jackson, I. T.: Naso-maxillary hypoplasia- the Le Fort II osteotomy. Br. J. Oral Surg., 11: 77, 1973.  Back to cited text no. 2    
3.Rintala, A., and Ranta, A.: Nasomaxillary hypoplasia- Binder's syndrome. Morphology and treatment of two separate varieties. Scand. J. Plast. Reconstr. Surg., 19:127, 1985.  Back to cited text no. 3    
4.Jackson, I. T., Moos, K. F., and Sharpe, D. T.: Total surgical management of Binder's syndrome. Ann. Plast. Surg., 7:25, 1981.  Back to cited text no. 4    
5.Gillies, H. D.: Deformities of the syphilitic nose. Br. Med. J., 29:977, 1923.  Back to cited text no. 5    
6.Banks, P., and Tanner, B. :The mask rhinoplasty: A technique for the treatment of Binder's syndrome and related disorders. Plast. Reconstr. Surg.92: 1038, 1993.  Back to cited text no. 6    




 

Top
Print this article  Email this article
Previous article Next article

    

Site Map  |  Home  |  Contact Us  |  Feedback  |  Copyright and Disclaimer
Online since 11th March '04
Published by Medknow