여러 가지 방법으로 교정한 Binder 증후군: 비상악골의 사진계측학적분석

Abstract

Binder's syndrome has some characteristic signs, such as orbital hypotelorism, shortened and flat noses, diminutive columella, crescent shaped nostrils, acute nasolabial angle, convex upper lip, class III malocclusion, absent anterior nasal spine, and maxillary hypoplasia. Binder's syndrome patients usually need the correction of the following three: the hypoplatic nose, the perialar flatness due to underdevelopment of the piriform margin, and the hypoplastic maxilla with its malocclusion. The authors treated eleven(n=14) patients through various surgical techniques depending on the clinical signs. In order to correct the nasomaxillary hypoplasia, the autogenous bones, the autogenous cartilages and the alloplastic implants were used. In three patients with severe nasomaxillary retrusion, the combined Le Fort I and II osteotomies and the perinasal osteotomy were performed. The results were analyzed using the proportion indices from the preoperative and postoperative lateral photographs of the patients. The postoperative values of all the proportion indices were significantly higher compared to the preoperative ones. For nasal dorsal augmentation, columellar lengthening and peripiriform augmentation, autogenous bone grafts were found to be very effective. The use of high-density porous polyethylene sheets for columellar lengthening was preferred over the use of nasal septal cartilages. Two types of osteotomy were the most effective for nasomaxillary augmentation in severe deformity.

Binder 증후군을 잘 교정하기 위하여 동반된 형성부전의 징후들을 코, 이상구주위, 상악골 등 3가지로 나누어 비성형술과 이상구주위증대술로서 자가골이식술, 자가연골이식술이나 이물성형물삽입술을 시행하였고, 제 3형 부정교합이 동반된 상악골형성부전에서는 Le Fort I과 II절골술 병행을 시행하여 교정하였다. 콧등증대 및 코길이연장에는 두정골외판이 늑골과 같은 자가골이식술이 실리콘고무보다 더 효과적이었으며 코기둥길이연장에도 다른 물질보다 더 우수하였고, 코기둥연잘술에서는 단단한 고밀도다공성폴리에틸렌판이 양이 적으며 단단하지 못하여 잘 휘는 비중격연골이식보다 코높이증가와 코기둥길이연장에 더 효과적이었다. 이상구주위증대를 위해서는 자가골이식이 바람직하다. 심한 비상악골함몰에서 상악절골술의 효과는 다른 방법에 비하여 탁월하였다.