The patient D.G. came to our clinic at the age of 14 years.
Parents in their medical history of early childhood noticed a crushing of the child's nasal pyramid associated with the manifestation of class III malocclusion in children.
Therefore, orthodontic therapy of palatal expansion and vestibuloversion of the upper group was initiated, trying to compensate class III, with scarce aesthetic and functional results.
Upon our observation, the patient, in frontal, lateral and axial view, presented an alteration of the facial eurhythmia characterized by: high forehead and crushed with a nasofrontal dorsal groove angle of approximately 180oves;
Intraoral examination revealed severe skeletal class III malocclusion with 3 mm overjet, open bite in the posterior latero-posterior sectors, bilateral bite of the maxillary arch and linguo-lingual elements.
An increased cephalometric exam (NB angle) showed absence of anterior nasal spine, reduction of anterior cranial base (SN = 73 mm), marked reduction of mandibular depth angle 82 (NA^FH).
Cervical radiographs excluded malformations of this segment.
Based on the clinical examination and radiographic appearance, Binder's syndrome was diagnosed and a preoperative orthodontic treatment was indicated.
At the age of 18 years, the patient underwent a surgical intervention of Le Fort I osteoarthrosis of the upper jaw of anterior symmetrical elevation of 1 mm and posterior maxillary occlusion of 3 mm, bilateral suer sagittal osteotomy.
One year after this procedure, it was decided to perform an intervention consisting of lengthening of the columella through v-y plasty and costal cartilage graft is anterior nasal rhinoplasty.
The follow-up of the last intervention is 13 months and the aesthetic and functional results are excellent.
