Statement of the problem: We analyzed the functional and esthetic results after combining orthognathic surgery with L-shaped parietal bone graft rhinoplasty in patients with Binder’s syndrome.

Materials and methods: 10 patients between 14 and 40 years of age (average 22.5) with maxillo-nasal dysplasia were treated with surgical-orthodontics and intraoral L-shaped parietal bone grafting rhinoplasty. Patient’s records included clinical, radiographs and photographs analysis, pre and post operative.

The patients were followed from 1 to 12 years with an average of 5.4 years. Orthognathic surgery included either a Le Fort I, bilateral sagittal split, subapical and genioplasty osteotomies according to clinical needs.

All patients received orthodontic treatment. One patient was dentally compensated, obviating the need for orthognatic surgery. The parietal grafts were meticulously tailored, the grafts were ensembled with a 1.5 mm plate and screws to unite the dorsal and columella grafts. A tunnel is created intraorally from the anterior maxilla, through the nasal dorsum, up to the glabellar area. A 12 mm long screw was utilized to fix it to the sub-glabellar site and a plate to the anterior maxilla. Those patients with thin nasal skin required a secondary auricular graft 4/10.

Results: 3-D maxillonasal corrections were obtained with ideal occlusion, adequate cosmetic and functional results. All patients expressed satisfaction

Conclusion: A combination of Orthodontics, Orthognathic Surgery and Rhinoplasty ideally correct the maxillo-nasal deficiency, with stable clinical and radiographic findings in the long term follow up.

Conflict of interest: None declared.