Augmentation with cartilage grafts around the pyriform aperture to improve the midface and profile in binder's syndrome.

The two major surgical methods for improving the midface and its profile of Binder's syndrome (commonly referred to as "dish face" deformity of "C-shape" deformity) are bone or cartilage graft and osteotomy. The bone or cartilage graft limited to the nasal sill area is ineffective in changing the flatness of the paranasal area. Furthermore, Le Fort II osteotomy has distinct disadvantages with possible damage to the patients and an additional Le Fort I osteotomy or orthodontic therapy is required to rearrange the occlusion of the patient with no malocclusion. A cartilage graft not only on the nostril sill area and the dorsum, but also around the pyriform aperture, makes it possible to augment the paranasal area and infraorbital area without osteotomy. Cartilage is an ideal material for grafting, since it tolerates absorption and is harvested in large volume. This surgical technique was applied to two Binder's syndrome patients and good midface profiles were achieved. We believe this technique would also apply to mild cases of Binder's syndrome and other maxillary hypoplasia without severe malocclusion.