Chummun Shaheel, McLean N R, Nugent M, Anderson P J, David David J
Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom.
J Craniofac Surg. 2012 Jul;23(4):986-90. doi: 10.1097/SCS.0b013e31824e2683.
Patients with chondrodysplasia punctata (CDP) usually present with Binder-type features, and often CDP is misdiagnosed as Binder syndrome. This study reviewed the management and outcome of patients with Binder syndrome and CDP in a multidisciplinary setting.
The notes and radiographs of the patients managed at the Australian Craniofacial Unit with a multidisciplinary setting since 1976 were reviewed, and data were collected on patient demographics, associated medical and surgical problems, subsequent management, and complications.
Seventy-seven patients were treated over the 30-year period (5 patients were lost to follow-up); of the remaining 72 patients, 60 (83%) had Binder syndrome, and 12 (17%) were patients with CDP. Forty were males, and 32 were females, with an age range of 6 months to 47 years. Thirteen patients (18%) had a strong family history, and 65 patients (90%) have so far undergone surgical correction, and of those, 35 (54%) have completed their treatment, the longest follow-up time being 18 years. The mean number of surgical procedures was 2.4, and 18 patients (28%) had postoperative complications, which included partial necrosis of the maxilla, osteomyelitis of the mandible, facial nerve and inferior alveolar nerve neuropraxia, nasal bone graft exposure, and cellulitis.
Because of the phenotypic characteristics shared by both Binder syndrome and CDP, it is most likely that Binder syndrome is not a syndrome, nor is it an entity, but most likely to be an "association." We would advocate that these patients should be managed in a multidisciplinary setting.
点状软骨发育不良(CDP)患者通常表现出Binder型特征,CDP常被误诊为Binder综合征。本研究回顾了多学科环境下Binder综合征和CDP患者的治疗及预后情况。
回顾了自1976年以来在澳大利亚颅面外科接受多学科治疗的患者病历和X光片,并收集了患者人口统计学、相关内科和外科问题、后续治疗及并发症的数据。
在这30年期间共治疗了77例患者(5例失访);其余72例患者中,60例(83%)患有Binder综合征,12例(17%)为CDP患者。40例为男性,32例为女性,年龄范围为6个月至47岁。13例患者(18%)有家族病史,65例患者(90%)已接受手术矫正,其中35例(54%)已完成治疗,最长随访时间为18年。平均手术次数为2.4次,18例患者(28%)出现术后并发症,包括上颌骨部分坏死、下颌骨骨髓炎、面神经和下牙槽神经失用、鼻骨移植暴露及蜂窝织炎。
由于Binder综合征和CDP具有共同的表型特征,Binder综合征很可能既不是一种综合征,也不是一个独立的疾病实体,而更可能是一种“关联”。我们主张这些患者应在多学科环境下进行治疗。