The parents of a baby with a unilateral cleft lip approached our hospital following a referral from their hometown doctor. Upon their visit, they were counseled by our expert team and advised to return when their child reached three and a half months of age for the appropriate surgical intervention.

In this particular case, the deformity was isolated to the lip, leaving the alveolus intact. While seemingly less complex than a  cleft lip and palate deformity, these cases often present unique challenges due to the delicate nature of the lip and the high expectations for aesthetic outcomes.

At three and a half months old, the baby underwent cleft lip repair surgery under the expert care of Dr. S. M. Balaji , our Chief Consultant and Head Surgeon. Using his innovative technique, Dr. Balaji achieved remarkable results: a minimal scar on the lip, a symmetrical nose with a straight columella, and preservation of growth centers.

With over 30 years of experience and more than 10,000 cleft surgeries to his credit, Dr. Balaji has perfected advanced techniques that not only ensure exceptional aesthetic results but also minimize the need for secondary surgeries.

The results of this child’s surgery were outstanding. The baby now enjoys excellent facial aesthetics, a beautiful smile, and is on the path to developing clear speech—a testament to the transformative power of expert cleft care.

​This little girl and her parents were referred to our hospital (Balaji Dental and Craniofacial Hospital) for the treatment of a lower lip hemangioma. The hemangioma was affecting her confidence, appearance, and lip functionality.

Hemangiomas are benign, non-malignant of blood vessels growths that commonly affect infants and children. They can appear anywhere on the body, but are most common place might be on the face, back, chest, and head. 

They are more common in females than males, and are more likely to occur in premature infants.  In India, 0.1–0.28% of neonates are reported with hemangiomas. 
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Our hospital is a specialty center for oral and maxillofacial surgery. We are a leading center for facial cosmetic surgery. Our hospital provides the best possible results for facial surgery. We pay special emphasis to ensure that there is minimal visible scarring from surgery.
During treatment for a hemangioma, extra care must be taken to ensure that there is no excessive bleeding. This is done through extensive preoperative planning with all pertinent investigations performed before surgery.

Dr. SM Balaji performed a meticulous surgical excision, removing excess tissue along pre-planned markings while carefully cauterizing the blood vessels to minimize bleeding. The procedure restored the natural contour and proportions of her lip, significantly enhancing both aesthetics and function.

This gentleman was born with microtia of the right ear. Microtia is the congenital deformity of the external ear. Reconstructive surgery is performed in two stages. He presented to our hospital for surgical correction of his microtia ear deformity. 

A template was first made using the left ear to ensure that the reconstructed right ear was symmetrical to the normal left ear. Costal rib graft with perichondrium was then harvested from the patient. The graft was crafted using the template for reconstruction of the right ear. Markings were made in the region of the deformed right ear and a subcutaneous pocket was created. The crafted cartilaginous graft was placed in the pocket and the incision was closed with sutures.
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The second stage was performed in four months with lifting up of the cartilaginous graft along with placement of a skin graft in the postauricular region. This resulted in reconstruction of a symmetrical right external ear.

This child was born with unilateral macrostomia, which was on the left. There were no other associated structural abnormalities. Her parents presented at our hospital for corrective surgery. Treatment planning was explained to them and they consented to surgery.

The new commissure was marked to ensure postsurgical symmetry with the normal right side. Orbicularis oris was reconstructed using the vermilion return flap. Repair was performed in three layers using the muscles, subcutaneous tissue and skin. This would result in negligible scar formation.

She will now be able to speak clearly and eat without dribbling. Her appearance was also completely normalized with establishment of symmetry. Her parents were very pleased with the results of the surgery.

This baby girl had been born with a unilateral isolated cleft lip deformity. This is the mildest form of cleft deformity, but the most difficult surgery to get best results. Her parents had been counseled at the time of her birth and referred to our hospital.

The nasal sill was addressed using a C-flap. It was then decided to do a three layer closure of her cleft lip deformity. The orbicularis oris, subcutaneous tissues and skin were reapproximated with extreme precision with the use of a surgical loupe. There was perfect recreation of lip anatomy.
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The postoperative picture is at the 7th day after surgery. Her parents were extremely happy with the results of the surgery.

This young girl with hypertelorism was first operated on when she was six years old. Her parents presented with her once she had completed bone growth as instructed at the time of the initial surgery for further corrective surgery. A revision hypertelorism surgery was planned with a box osteotomy and facial bipartition procedure.

Comprehensive studies were obtained preoperatively including axial section CT scans of the facial bones. A mock surgery was then performed on a 3D stereolithographic model of her skull in consultation with the neurosurgical team that was closely involved in each step of the treatment process.

A bicoronal flap was raised and craniotomy was performed after removing previous screws and plates. Extreme care was taken to ensure that there was no damage to the duramater and the traditional frontal bar cut was performed.

Care was taken to preserve the olfactory bulb while handling the crista galli region. The segmental cuts were made with great care and medial nasal part was removed. This was followed by the orbital cut of the box osteotomy, which was performed as planned. Great care was exercised while handling the nasolacrimal duct to ensure that there would be no complications in the future.

The lower cut performed intraorally would result in movement of the midfacial segment alone and not the entire alveolus. After completely mobilizing the midfacial segments and removal of excess tissue, the edges were approximated. The frontal bar served as a standard guide for this procedure. They were secured with plates and screws. The position of external eye and nose were rechecked. Then the incisions were closed in layers.

There was optimal correction of the patient’s hypertelorism following the surgery. She would need a series of further surgeries to complete the rehabilitation process.

This little girl was born with a right-sided hemifacial microsomia with macrostomia. Hemifacial microsomia might be genetic or can be acquired through disruption of in utero vascular supply to the facial region. It is most commonly unilateral.

She had right-sided macrostomia, a short lingual frenum with resultant tongue tie and a prominent right preauricular cartilaginous ear tag.

The short lingual frenum was addressed first. Fibers of the lingual frenum were dissected free and the tongue tie was released. Her right-sided macrostomia was corrected using a vermillion return flap technique. This involved reconstruction of the modiolus on the right side.

The orbicularis oris muscle was first identified and sutured. Buccinator was then identified and sutured. This resulted in a symmetrical reconstruction of the angle of the mouth.

Attention was then turned to the right ear tag. An incision was made and the cartilaginous part of the ear tag was dissected and excised. The incision was then closed resulting in establishment of good facial esthetics for the little girl from the surgery.
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Her parents were extremely satisfied with the results of the surgery.

This young man had suffered a bullet injury to the right infraorbital region, had suffered from extensive injuries including a blow out fracture of the right orbit and had undergone extensive reconstruction in the first stage of surgical correction of his deformities.

He now presents for second stage surgery for correction of resorption of infraorbital fat, ectropion deformity and excessive scleral show of his right eye. Treatment planning was explained to him and he consented to surgery.

A subdermal fat graft was harvested and tunneled into the infraorbital region for reestablishment of symmetry. He then underwent superior repositioning of his lateral canthal ligament with correction of his ectropion and excessive scleral show.

He was very happy with the results of the surgery.

This little girl had a congenital bilateral cleft lip and palate deformity. Her parents were counseled regarding her cleft deformities at the time of her birth.

She was brought to our hospital for surgical correction when she was 8 months old. Her bilateral cleft lip deformity was addressed first. She had a very wide cleft with a mobile premaxilla. Her prolabium was also very tiny along with a very short columella. There was also very minimal tissue for reconstructing the lip.
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She underwent a single stage repair utilizing Paul Black’s technique. No cross incision was made at the prolabium. Available prolabium and columella were utilized for reconstructing the philtral column and Cupid’s bow.

This was followed by creation of the nasal floor and vermillion. Bilateral C-flaps were utilized for this. Extreme care was taken as there was very minimal tissue available. This was followed by meticulous three layer closure of the cleft lip under loupe magnification. Orbicularis oris muscle was approximated at the midline. This was followed by approximation of the subcutaneous tissue and skin.
Her parents were extremely happy with the results of the surgery.

This little boy had incomplete bilateral cleft lip and palate deformity. This was very mild. His parents were extensively counseled regarding the management of his deformity and sent to our hospital for corrective surgery.

His bilateral cleft lip deformity was addressed first. At the age of 3 months, he underwent a single stage repair utilizing Paul Black’s technique. No cross incision was made at the prolabium. Available prolabium and columella were utilized for reconstructing the philtral column and Cupid’s bow.

This was followed by creation of the nasal floor and vermillion. Bilateral C-flaps were utilized for this. This was followed by meticulous three layer closure of the cleft lip under loupe magnification. Orbicularis oris muscle was approximated at the midline. This was followed by approximation of the subcutaneous tissue and skin.
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Her parents were extremely happy with the results of the surgery.

This young man was born with a unilateral cleft lip and palate deformity, which was surgically corrected as an infant. He presented to our hospital stating that he wanted correction of his nasal deformity as well as the hypertrophic lip scar.

Examination revealed a noticeable depression in the right anterior maxillary region, which caused the right nostril to be depressed. He also had a flattened nasal bridge and a hypertrophic scar on his lip.
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The depression in his right anterior maxilla was addressed using bone grafts harvested at the time of surgery. A costal graft was then utilized to augment the bridge of his nose. This was followed by a lip scar revision surgery as well as a Weir excision for left alar base correction.

This resulted in a symmetrical nasal form and he was very happy with the results of the surgery. He profusely thanked the surgical team before final discharge from the hospital.

​The patient is a 14-year-old boy who was born with a deformed right external ear. There was just a rudimentary structure in place. He had faced significant bullying in school. One of his greatest wishes in life was to be able to wear sunglasses like his father. His parents’ widespread enquiries for the best surgeon to address this issue led them to our hospital.

​Dr SM Balaji, microtia ear deformity surgeon, examined the patient and obtained detailed measurements of his normal left ear. He explained to the parents that the surgery needed to be performed in two stages. It was further explained that cartilaginous grafts needed to be harvested for the procedure. The parents consented to the procedure

​Under general anesthesia, a costochondral graft with an intact synchondrosis was first harvested from the patient. This was in the form of an ‘E’ in order to recreate the cartilage of the external ear. Using a template created from the measurements obtained from the normal ear, the graft was carved to recreate the external ear form.
Attention was next turned to placement of the costochondral graft at the site of the deformed right ear. A subcutaneous pocket was created followed by insertion of the graft into the pocket. The incision was closed and a period of three months was allowed to elapse before the second stage.

​A full thickness skin graft was harvested from the patient’s inguinal (groin) region. This was followed by incising around the cartilaginous graft and raising up the entire superstructure of the recreated right ear. The skin graft was then sutured to cover the exposed tissue behind the recreated pinna. A period of one month was allowed for full healing of the surgical site.

​The patient and his parents were very happy with the results of the surgery. He was now able to realize his long-cherished dream of wearing sunglasses like his father. His earlobe had also been perfectly recreated. They expressed their profuse gratitude to the surgical team before final discharge from the hospital.

​This middle aged lady first noticed the swelling on her anterior left mandible two years ago. This was followed by loosening of teeth in the region. A local dentist had obtained an x-ray and diagnosed this to be a cystic lesion with an impacted tooth. He had attempted removal of the cyst; however, this had not resolved but had got infected. 

​Dr SM Balaji, jaw reconstruction specialist, examined the patient and obtained a biopsy. Biopsy confirmed this to be a dentigerous cyst. He advised resection followed by reconstruction with rib grafts and rehabilitation with dental implants.
 
The patient consented and subsequently underwent successful jaw reconstruction with rib grafts. She was advised to return in three months following bony consolidation of rib grafts with alveolar bone.

​The patient returned for dental implant placement after three months. Four Nobel Biocare dental implants were placed in the well consolidated alveolar bone. The patient was then instructed to return in four months to allow for implant osseointegration with bone.
 
Upon returning after four months, a ceramic bridge was fabricated in our in-house dental laboratory for the patient. Her bridge was then cemented to the implants to complete her rehabilitation.

​The patient expressed her complete satisfaction at the overall treatment experience at our hospital. She thanked the surgical team for her successful rehabilitation before discharge from the hospital.

She presented with a complaint of backwardly placed upper jaw. This gave her an aged look. She was also unhappy with her face. The patient wanted to have a more pleasing face. She was unable to bite and chew food.

A local dentist had mentioned that her upper jaw was small at a young age. He stated that she will have orthodontic problems in the future. He started noticing the difference when she was in a mixed dentition period. He had suggested that she would require orthognathic surgery at a later age or risk developing jaw joint pain.

He had reviewed her at about 18 years of age. During which he noticed that she did not have a proper bite relationship. The upper and lower teeth were completely malaligned. She had a lot of dental issues. There was also a noticeable anterior crossbite. The roof of her mouth was normal after surgical correction of cleft palate.​

​She had an abnormal bite. The upper and lower jaw was in an abnormal position. Every single tooth including the upper molars was also abnormally placed. She had an anterior and posterior crossbite. This is also known as a complete crossbite. The patient had a more curved facial profile. Her profile was concave. This showed that she needed advancement of the maxilla.

​Radiological evaluation revealed backwardly placed upper jaw. This was due to restricted growth of maxilla. The growth of mandible was normal. Since the maxillary jaw growth was restricted, the mandible looked longer. The upper front teeth were placed inside the lower front teeth.

​Maxillofacial surgeon Dr.S.M.Balaji advised upper jaw surgery by bringing the maxilla forward.   Maxillary advancement was planned by Le Fort I osteotomy. The segment was to be fixed using Ti plates and screws. An incision made in the maxilla. Flap elevated. Bone cuts made above the apices of the teeth. Pterygomaxillary dysjunction done.  The maxillary segment was mobilized. The maxilla was pulled forward. It was brought in occlusion and fixed using Titanium plates and locking screws (Ti L plate). The maxillary vestibular region was sutured.

​The patient was greatly satisfied with the results. The surgery was successfully performed. The maxilla was successfully brought forward. The anterior crossbite and posterior crossbite was corrected. The patient will, however, require post-surgical orthodontic treatment for minimal teeth alignment.