Long-term behavior of three different grafts in nasomaxillary reconstruction of binder syndrome: an analysis by digitalized measurements.

Background: Growth inhibition of the ossification center, "the external trabecular network," would result in localized hypoplasia of nasomaxillary structures, resulting in the typical features of the Binder syndrome patient, with the retracted columella/lip junction and a lack of the normal triangular flare in the lower part of the columella. This study focused on a long-term follow-up of more than 5 years for three different grafting techniques. Methods: Ninety-two patients with Binder syndrome were subjects for consecutive reconstructive plastic surgery between 1972 and 1995. The primary surgical approach was degloving the midface subperiosteally, and reconstruction was identical but differed in the grafts used: septum repositioning (n = 26), L-shaped bone graft (n = 51), or L-shaped cartilage graft (n = 15). Anthropometric variables on digitalized profile photographs were used. Results: The angle of convexity of the face at the tip of the nose (glabella-pronasale-pogonion) improved in all three groups from 155 to 158 degrees to 144 to 149 degrees at the short-term follow-up and to 148 to 149 degrees at the long-term follow-up. The nasolabial angle changed, from a narrow angle of 76 to 88 degrees in all groups before surgery, to 100 to 106 degrees at the long-term follow-up after surgery. Conclusions: The L-shaped bone graft was favorably used in the depressed nasal dorsum, whereas frontal repositioning of the septum was optimal when the upper part of the nose was considered normal. The consistency in tip projection for all groups over time may be explained by the extensive surgical release of the soft tissues before grafting.