Wang Hengjian, Yuan Jie, Zhang Ying, Qi Zuoliang, Wei Min
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Craniofac Surg. 2013 Jan;24(1):200-3. doi: 10.1097/SCS.0b013e3182668752.
Maxillonasal dysplasia, or Binder syndrome, is a congenital condition consisting of midfacial hypoplasia with a characteristic of flat nasal deformity. Overall goal of treatment is to advance skeletal dysplasia of the midface and correct the deformities of the flat nose. Surgical approach is mainly varied with the degree of deformity from simple nasal implant to complicated naso-maxillary osteotomy. In our study, we reported 8 patients with maxillonasal dysplasia using modified naso-maxillary complex and hard palatine "box" osteotomy, combined with chondrocostal bone grafts or nasal implant to correct the retruded nasal deformity. The technique has been used in all patients with ages and degree of deformity. All patients were satisfied with outcome of operation, no severe complication was found. Six-month follow-up evaluation showed good correction of the midface profile and nasal projection, the advancement of midface was found stable, chondrocostal bone graft was fixed perfectly, and no obvious absorption and remodeling was found in short time. The lateral cephalometric analysis and superimposition results showed after the operation, sella-nasion distance had been increased approximately 5 mm, and SNA angle had been increased about 10 degrees. Soft tissue measurement showed the facial convexity angle has increased 8 degrees; the nasolabial angle had increased about 10 degrees after surgery. The tip of the nose had moved 10.0 mm anteriorly and 3.0 mm coronally, respectively. As the result showed modified nasomaxillary complex and hard palatine "box" osteotomy can be a good alternative for advancement of midfacial hypoplasia instead of traditional Le Fort I, II osteotomy, chondrocostal bone graft is a perfect option to correct nasal deformity of Binder syndrome, and both can satisfy requirement of patients.
上颌鼻发育不全，即宾德综合征，是一种先天性疾病，其特征为面中部发育不全并伴有扁平鼻畸形。治疗的总体目标是改善面中部的骨骼发育不全并纠正扁平鼻畸形。手术方法主要根据畸形程度而有所不同，从简单的鼻植入到复杂的鼻上颌截骨术。在我们的研究中，我们报告了8例上颌鼻发育不全患者，采用改良的鼻上颌复合体和硬腭“盒状”截骨术，联合肋软骨移植或鼻植入来纠正后缩鼻畸形。该技术已应用于所有不同年龄和畸形程度的患者。所有患者对手术结果均满意，未发现严重并发症。六个月的随访评估显示，面中部轮廓和鼻突度得到了良好的矫正，面中部的前移稳定，肋软骨移植固定良好，短期内未发现明显吸收和重塑。头颅侧位片分析和叠加结果显示，术后蝶鞍-鼻根距离增加了约5毫米，SNA角增加了约10度。软组织测量显示，面部凸度角增加了8度；术后鼻唇角增加了约10度。鼻尖分别向前移动了10.0毫米和向上移动了3.0毫米。结果表明，改良的鼻上颌复合体和硬腭“盒状”截骨术可以作为改善面中部发育不全的良好替代方法，而不是传统的勒福I型、II型截骨术，肋软骨移植是纠正宾德综合征鼻畸形的理想选择，两者均能满足患者需求。
