Correcting Binder Syndrome Nasal Deformity With Cartilage Grafts And The Post-Transplant Cartilage Degeneration

Objective:To investigate the nasal feature of Chinese Han Binder syndrome.To figure out nasal differences between normal Han female,Caucasian Binder,Mexican Binder and Chinese Han Binder syndrome.To investigate the surgical details and clinical outcomes of costal cartilage and L shaped silicon covered with auricular cartilage correcting the nasal deformity of Binder syndrome.To study the degeneration of auricular cartilage and costal cartilage after transplanted to nasal tip.Methods:1.Selected effective anthropometric proportions to clarify Binder syndrome nasal features according to Farkas anthropometry and Binder-related studies.Twenty-eight Chinese Han Binder nasal profiles were estimated using anthropometric system established.Results were compared with normal Chinese Han female,Caucasian Binder noses,Mexican Binder noses reported in articles.2.A total of 25 cases of Binder syndrome were enrolled and divided into two groups.Nine patients were corrected with silicon-auricular cartilage and 16 with costal cartilage.Anthropometric method in part one was used to measure the nasal contours pre-surgery and post-surgery.Complications,surgical details were also illuminated.3.To identify histologic degeneration,auricular cartilages and costal cartilages transplanted for series of time periods were collected and made pathological sections of HE staining,type?collagen immunohistochemical staining,elastic fiber dyeing.4.To identify biomechanical degeneration,post-transplanted auricular cartilages and costal cartilages underwent biomechanical experiments testing bending relax,stress-creeping,stress-strain relation,tensile strength and compression strength.Results:1.Compared to normal Chinese Han female,Binder Han women had equal nasal index,flat nasal frontal angle(difference up to 9.54 degrees),smaller nasal facial angle(difference up to 20.47 degrees).Nasal deep-width index was 4.4%lower.Columella-nasal deep index decreased 18.57%.Nasolabial angle was 18.25 degrees below normal.Compared to Caucasian Binder patients,Chinese Han Binder patients had equal facial projection 1,facial projection 2 but difference of facial projection 3 was statistically significant.Chinese Han Binder had a smaller nasolabial angle.Compared to the Mexican Binder patients,Chinese Han Binder had a lower tip projection.Other proportions had no statistical difference.2.Silicone Group:Follow-up period was 18.67(8.71)months.Two cases received secondary rhinoplasty due to implant deviation or pursuing better esthetic outcomes.Costal cartilage Group:Follow-up period was 13.92(4.66)months.Five cases showed nostril asymmetry and two complained about paranasal stiffness when chewing due to the alar base implants.Both two groups can improve Binder nasal depression but costal cartilage group had better improvement of facial projection,nose tip-length quotient and nasolabial angle.3.Normal cartilage cells had round shape,continuous matrix.With the increase of transplanted years,auricular cell number increased then return to medium.Connective tissue grew into cartilage edge.Local fibrosis was visible in the matrix.Cellular secretion of type ? collagen increased then declined and secretion of elastic fibers declined.Three years after transplantation,costal cartilage had uniform matrix,but cells secretion of collagen type ? declined.4.Along with the increasing period of transplantation,auricular and costal cartilage mechanical performance changed:stress-strain curves moved towards right,relaxation curves moved upward and creeping curve downward which indicated a higher viscosity and lower resilience.Auricular cartilage achieved a stronger tensile strength,higher compressive strength and elastic modulus.Costal cartilage got a lower tensile strength and elastic modulus.Conclusion:1.Compared with normal Han women,Binder Han women had short columella,flattened tip and alar wings,half-moon shaped nostrils,acute nasolabial angle and frontonasal angle of almost 180 degrees.Compared with Caucasian Binder,the Han patients had more flat facial profile.Compared with Mexican Binder patients,Han patients had lower tip projection.2.Costal cartilage achieved better nasal esthetic outcome than silicone method.Silicone technique could be a compromised choice when costal cartilage could not be obtained.3.After years of transplantation,auricular cartilage histology changed more like hyaline cartilage.Elastic fiber secretion declined while type II collagen increased.Chondrocyte secretion of collagen type II declined post transplanted.4.Along with the increasing period of transplantation,auricular and costal cartilage mechanical performance indicated a higher viscosity and lower resilience.Auricle cartilage had a stronger tensile strength,higher compressive strength and elastic modulus.Costal cartilage had a lower tensile strength and elastic modulus.