Total surgical management of Binder's syndrome.

Binder's syndrome consists of nasomaxillary hypoplasia with a characteristic nasal deformity. Occlusion may be normal or class III. The cephalometric appearances are almost characteristic. The Le Fort II osteotomy is ideal for correcting the problem, though initial results were not entirely satisfactory because of incomplete correction of the nasal deformity. Over the past few years the periosteum of the floor and lateral walls of the pyriform cavity has been widely dissected to obtain adequate nasal advancement. The alar base, nostril sill, and nasal spine area have been selectively augmented with carved bone or cartilage grafts. Lengthening of the columella has been achieved by advancement of bilateral nostril sill flaps into the columella. Advancement of the maxilla with a previously normal occlusion may require orthodontic treatment, either preoperatively or postoperatively, to ensure normal occlusion. The authors have treated 26 patients with this condition over the last ten years.