Yamani Venkata Ramana, Ghosh Shakuntala, Tirunagari Shreekumar
Contours Plastic Surgery Center, Hyderabad, Telangana, India.
Indian J Plast Surg. 2016 Sep-Dec;49(3):314-321. doi: 10.4103/0970-0358.197237.
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.
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.
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.
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.
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.
鼻上颌骨发育不全是一种累及面部中央的罕见先天性疾病。随着年龄增长，它会使个体面部呈现出独特外观。该疾病的严重程度各不相同，表现也各异。
这是一项回顾性研究，对2006年3月至2016年3月期间进行的560例隆鼻手术的记录和照片资料进行分析。从该组中选取约16例鼻上颌骨发育不全病例，并根据特征严重程度进行分类。详细介绍了每组所进行的手术矫正方法。
在我们中心进行的560例隆鼻手术中，3%为宾德综合征病例。轻度病例采用局部自体软骨移植进行鼻矫正即可。中度和重度病例需要局部软骨移植加肋软骨移植。在中度和重度病例中，进行鼻前底和鼻翼基部增大手术以获得合适的美学外形。轻度和中度病例术后效果极佳，重度病例效果尚可接受。
我们试图在鼻和上颌骨生长完成后才进行畸形矫正。我们以软骨移植作为主要方法，因为与骨移植不同，软骨具有长期稳定性且不会吸收。我们没有采用整块软骨组装技术，而是分别重建鼻背、鼻小柱和鼻尖，因为这一原则在功能上更易接受，且鼻子的扭曲或僵硬程度较小。重视移植物的妥善固定。
我们试图根据先前对鼻解剖参数的人体测量学研究，将各种特征归纳为轻度/中度/重度三类。我们研究的第二个目标是为每组提供一个合理的手术方案，以便未来的外科医生能够遵循一个简便的手术指南，以获得最佳的美容和功能效果。
