Maxillofacial Surgeon Dr. S.M. Balaji accessed the cystic lesion raising a gingivomucoperiosteal flap and completely enucleated the cyst. The affected teeth were extracted. The removal of the lesion left a large bone defect. For complete closure of the defect and to enable implant placement in future, the defect size was measured, a bone graft of the same size was harvested from the mandibular symphysis and placed in the bone defect successfully closing it. After subsequent healing, implants & ceramic crowns will be placed for fixed replacement of lost teeth.
A 35-year-old female reported to our hospital with a complaint of severe pain and swelling with respect to her upper front teeth. A digital x-ray revealed a large cystic lesion at the root apex of maxillary right central and lateral incisor with resorption of the roots. Maxillofacial Surgeon Dr. S.M. Balaji accessed the cystic lesion raising a gingivomucoperiosteal flap and completely enucleated the cyst. The affected teeth were extracted. The removal of the lesion left a large bone defect. For complete closure of the defect and to enable implant placement in future, the defect size was measured, a bone graft of the same size was harvested from the mandibular symphysis and placed in the bone defect successfully closing it. After subsequent healing, implants & ceramic crowns will be placed for fixed replacement of lost teeth.
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A 30 year old man from USA reported to our hospital seeking correction of his facial appearance. He was not happy with his broad flattened nose and upper jaw prominence giving him more aged appearance. He wanted to have cosmetic correction of his nose and jaw without any surgical marks on his face. After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected his nose and jaw simultaneously by following anterior maxillary excess removal along with subapical osteotomy for lower jaw and dorsal augmentation of the nose with costochondral graft via intraoral approach. Results were immediate. Patient was very happy to have an improved appearance and that his nose and jaw correction was done concurrently without any surgical marks on his face. An 18-year-old girl from Bangalore was brought to our hospital by her parents for expert correction of her protruding upper jaw that caused an unattractive “gummy smile”. The girl was about to begin her college education and she was very self-conscious about her appearance.
Her facial bones were analyzed using digital x-rays. Her upper jaw or Maxilla was disproportionately larger as compared to the lower jaw and her upper lip was short causing too much of the gums to be visible while smiling. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the corrective jaw surgery or orthognathic surgery with Le Fort I osteotomy. The upper jaw was set back, reshaped & realigned in perfect facial harmony. The entire procedure was done from inside the mouth so there were no scars. Immediately following surgery the girl’s appearance was greatly enhanced and her more attractive, pleasing smile boosted her confidence. A 20-year-old man reported to our hospital seeking to correct the appearance of his nose. His nose was much flattened in the middle and he wanted to have a sharp nose to improve his appearance. Maxillofacial surgeon Dr. S.M. Balaji expertly performed the augmentation rhinoplasty. A costochondral cartilage graft was harvested and used to reconstruct the depressed, collapsed dorsum of the nose. The surgery was done from inside the nose (closed rhinoplasty) so there was no scarring. The patient was very happy to have a sharp, defined & pristine nose immediately after surgery, which improved his appearance. A 1.5 year old boy with isolated cleft palate was brought to our hospital for the surgical closure of the gap (cleft) in the roof of the mouth (palate). The boy’s cleft palate defect was classified as Millard’s 10 and 11. Maxillofacial Surgeon Dr. S. M. Balaji surgically corrected the cleft palate using palatal pushback technique. Incision was made in the mid- vomerine region. The palatal flap was raised on both right and left side. The Levator palatine muscle was detached from their abnormal positions and reattached to its normal position like a hammock. A two layer closure was done. The nasal floor was closed with the vomerine flap making a reverse knot. Oral layer was sutured by vertical mattress sutures. Results are immediate and the suction test was positive which ensures improved speech. Suction test positive guarentees improved speech A girl with unilateral cleft lip and palate was brought to our hospital by her parents with the complaints of mal aligned teeth and escape of water through the nose due to the cleft defect. Primary cleft lip and palate repair was done elsewhere. Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct her alveolar cleft defect using iliac bone grafting technique according to her parents’ request. With very minimal incision line in the hip region, the iliac crestal bone was successfully harvested. The incision made was approximated in such a way resulting in very minimal scarring. The harvested graft was placed in the alveolar cleft defect region and approximated to the extent of defect. Patient was comfortable to have a very minimal incision mark left after surgery in her hip region resulting in good healing with very minimal scarring. Her parents were also happy to have her daughter to feel comfortable after surgery. They returned to their home place and were asked to come for further follow-ups and cleft management. A 40 year old man reported to our hospital with the complaints of huge swelling in the left side of face. He gave the history of previous surgery done elsewhere, were they have removed a tumor extra orally but it got recurred. He also explained about the nature of swelling as he had noticed the swelling 2 years back. But the swelling was small at that time, later it started to grow slowly and extended to the present size now. Initially he had tenderness in the cheek region, but later there was no pain. After thorough clinical and radiological examinations, it was diagnosed as recurrent Neurofibroma. Maxillofacial surgeon Dr. S. M. Balaji skillfully planned to remove the tumour completely as well as to reconstruct his face. Through the previously operated nasolabial scar, the tumor was exposed by raising the infra orbital skin. Tumor was separated from the maxilla and zygomatic bone and removed completely. Tumor was adherent to the previously operated site which was also detached and removed completely. The ectropion (turning out of the lower eyelid) in the left eye was repaired with lateral canthotomy incision and orbital septal return flap technique. The inferior tarsal plate was sutured with supra orbital periosteum. Excess skin in the nasolabial area was excised and wound closed in layers. A 28 year old male reported to our hospital with the complaint of deviated nose with depressed nasal bridge and left nostril. His nose was flattened with the ala in the varying level in both sides. Maxillofacial Surgeon Dr. S.M. Balaji corrected his nose by following Augmentation Rhinoplasty technique with Alar base correction. Cartilage graft has been harvested and sculpted for the correction of depressed nasal bridge. The nasal septum and foot plate of medial crus is removed surgically from the left side along with the correction of alar base. The surgery was done within the nose so there are no scars on the face. Results are immediate and he is happy to have a renewed confidence to have a pristine nose with a new, improved look. A 15 year old boy with unilateral cleft lip and palate from Tirupur reported to our hospital wanting to correct his nose and alignment of his teeth. Primary lip and palate repair was done in his hometown itself during his childhood. He and his parents were more upset regarding his scar results after lip repair which affect his moustache growth as well as his broad asymmetrical nose made his face look disproportionate. Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his cleft defects to overcome the future growth huddles. Considering their level of distress they had in the results of previous surgeries, multiple cleft defects were planned to be corrected in a single surgery. Deviated nasal septum was aligned through intra oral approach using chondral graft obtained from his rib. Thus his nose defect was shaped to normal shape and size. His cleft alveolar defect was closed with miracle protein rhBMP-2. His lip defect which was due to incorrect approximation of mucosal flaps leaving the vermillion of the lip defective. Thus, vermillion defect was corrected and scar formed due to incorrect technique was removed precisely with very minimal scar formation. Results are immediate showing enhanced appearance of his face due to pristine nose correction and scar revision. A 19-year-old boy from Trichy was brought to our hospital by his parents for the surgical correction of his abnormally large tongue due to which he had difficulty in speaking and closing his mouth. This condition is called Macroglossia. On examination, the boy had no associated symptoms or any other systemic illness. The surgery was carefully planned & meticulously executed by Maxillofacial Surgeon Dr. S.M. Balaji. The large tongue was surgically trimmed with utmost care taken not to damage the huge blood vessels inside the tongue. A modified resection design incorporating the Pichler's central reduction, modified key-hole, and Kole's approach were incorporated to form a rough clover shaped design. Following this technique, both the length and width of the tongue were reduced more precisely. By choosing this design, the sensitive nerves and the tip of the tongue were preserved so as not to compromise taste perception. The boy is now able to use the new normal sized tongue to speak, swallow and taste. A 28-year-old software engineer was brought to our hospital after he sustained injuries to his face in a road traffic accident. After immediate first aid, he complained of pain in the jaws and inability to bite properly.
A 3D CT scan taken showed a fracture in both the right & left mandibular condylar heads and both fractured segments were displaced inwards. This caused a derangement in the patient’s occlusion or contact between upper and lower teeth. Maxillofacial Surgeon Dr. S.M. Balaji performed the surgical fracture reduction. The fracture site was surgically exposed, the patient’s occlusion was accurately restored, the fractured segments were stabilized and fixed in their normal position with bone plates and anterior open bite was corrected. A 34-year-old lady reported to our hospital with a complaint of continuous tears running down her face from her left eye. She gave a history of having met with a car accident. Due to the traumatic injury, it was identified that the medial canthal ligament of her left eye had detached and come down. A defect in her nasolacrimal duct caused epiphora or abnormal tear flow. The normal flow of tears from the eye to the nose was damaged. The aim of the surgery was to correct the defect in the nasolacrimal duct with DCR or Dacryocystorhinostomy & reposition the medial canthal ligament. The ostium was opened with rongeurs, bone adjacent to nasolacrimal sac was removed. A new direct communication was created between the nasolacrimal sac & the nasal mucosa by placing a silicone tube to enable the tears to drain into the nose. The medial canthal ligament was repositioned using Y-plate canthopexy. |
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