Orthognathic Surgery and Rhinoplasty to Address Nasomaxillary Hypoplasia

Overview

Nasomaxillary hypoplasia means the middle of the face and the nose are underdeveloped. The article details the features that define it, known as the Binder phenotype, and sets out the senior author's preferred sequence of operations and the technical steps involved.

Sections of note

• The Binder phenotype is listed as: midfacial hypoplasia, class III malocclusion, small or absent anterior nasal spine, flattened nose, horizontal nostrils, short columella, acute nasolabial angle, and a flat frontonasal angle.
• Treatment is staged rather than done in one operation.
• Stage one is orthognathic surgery to achieve vertical maxillary length and forward advancement.
• Stage two is rhinoplasty aimed at increasing nasal tip projection, rotation, and columellar length.
• The article details diagnosis as well as treatment.
• Level of evidence V, therapeutic. No patient numbers, outcomes, or follow-up are reported.

What it means for a patient

• The bone foundation is corrected before the nose, because the nose sits on the jaw.
• Class III malocclusion means the lower jaw sits ahead of the upper jaw when the teeth meet.
• The nasal stage lengthens the strip between the nostrils and pushes the tip forward and up.
• This is a level V technique article, so it reports no results, complication rates, or follow-up.

Why this paper matters

Nasomaxillary hypoplasia is uncommon and treatment sequencing is the main practical question. Setting out the staged order gives a reference plan. The abstract offers no outcome data to show how well the sequence works.

Terms

• Nasomaxillary hypoplasia: Underdevelopment of the nose and the upper jaw.
• Orthognathic surgery: Surgery that repositions the jaw bones.
• Maxilla: The upper jaw bone.
• Class III malocclusion: A bite in which the lower teeth sit ahead of the upper teeth.
• Columella: The strip of tissue between the nostrils.