ABSTRACT
Background: Nasomaxillary hypoplasia is a rare congenital disorder involving the central face.
It imparts a distinctive appearance to the individual face as the age advances. Severity
of the disorder varies, so do the manifestations. Methods: This was a retrospective study conducted on the records and photographic data of
560 rhinoplasty cases performed between 2006 March and 2016 March. About 16 cases
of nasomaxillary hypoplasia were selected from the group and they were classified
based on the severity of the features. Surgical correction performed in each group
was detailed. Results: Three percent of the 560 rhinoplasties performed in our centre turned out to be cases
of Binder's syndrome. Nasal correction with locoregional autologous cartilage grafts
was sufficient in mild cases. Loco-regional cartilage grafts along with costal cartilage
grafts were needed for moderate and severe cases. Anterior nasal floor along with
alar base augmentation was performed to achieve a proper aesthetic profile in moderate
and severe cases. Post-operative results were excellent in mild and moderate cases
and acceptable in severe cases. Discussion: We attempted to correct the deformity only after growth of the nose and maxilla was
completed. We used cartilage grafts as a mainstay as cartilage has long-term stability
without resorption unlike bone grafts. Instead of following en bloc technique of cartilage
assembly, we have reconstructed the nasal dorsum, columella and tip separately as
this principle is more functionally acceptable with less warping or stiffness of the
nose. Importance was given to proper anchorage of grafts. Conclusion: We have attempted to put together the various features into three categories of mild/moderate/severe
based on previous anthropometric studies of nasal anatomical parameters. The second
objective of our study was to advise a logical surgical protocol for each group so
that future surgeons can follow an easy surgical guideline to attain optimal cosmetic
and functional results.
KEY WORDS
Binder’s syndrome - classification - nasomaxillary hypoplasia - rhinoplasty
