Balaji Dental and Craniofacial Hospital - Dr. S.M Balaji, Maxillofacial Surgeron, India - Best Dental Clinic in Chennai : Best Dental Implant Center in India

Cosmetic nose correction for broad flat nose without any scars

30/1/2015

Surgical correction of nose deformities also known as the “Nose Job” requires expertise and experience. The surgeons estimate the type of defect - either excess or deficit of the height, deviations, depressions and abnormally angled noses. The patient’s expectation of his/her nose is understood after careful examination.

Shown is a case with a deficiency of the bridge portion of nose. Note the midlevel of the nasal bone, where there is a deficiency creating a huge impact on the patient’s facial profile. This gives the nose a saddle-shape. Tip of the nose appears bulky and everted in the profile view; base of the nose appears broad. Maxillofacial Surgeon Dr. S.M. Balaji planned a closed rhinoplasty technique wherein the surgical approach is through the nose to prevent unsightly scars.

Appropriate measurement of nose was made and the amount of augmentation needed was noted. Autologous graft (rib graft) was harvested, shaped and positioned to improve the aesthetics of the nose. Bulky nose tip was corrected by removing the prominent lower lateral nasal septal cartilage and Weir excision done to reduce the width of the alar base. Results are immediate. The patient is very happy with the surgery outcome and his enhanced appearance without any visible surgical marks

Preoperative view showing broad nose with bulky nasal tip

Costochondral graft harvested from the ribs used to augment the dorsum of the nose

Intranasally costochondral graft inserted into the dorsum of the nose

Immediate postoperative view following nasal bridge augmentation and Weir excision giving enhanced appearance

Successful jaw joint fracture stabilization – the growth centre in an eight year old boy

28/1/2015

An 8 year old boy was brought to our hospital by his parents with the complaints of swelling and pain in both the jaw joints and inability to open his mouth due to an accidental fall from staircase.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed that there was a left condylar neck fracture with displacement. As the condyle is the growth centre for the lower jaw, Dr. Balaji planned to fix the fractured condylar segment into its correct position as early as possible. Through preauricular approach the broken and displaced portion of the left condylar segment was fixed into its correct position using 4 hole titanium bone plate and screws. Proper bite is maintained by intermaxillary fixation for 2 weeks postoperatively. Thus, fractured condylar segment was stabilized to avoid any future mandibular growth related problems. The boy is now on physiotheraphy for atleast a month to avoid trismus.

Preoperative 3DCT scan image showing left condylar neck fracture with displacement

Postoperative digital radiograph showing condyle fracture stabilization and intermaxillary fixation for healing betterment

Successful correction of TMJ ankylosis with Gap arthroplasty

26/1/2015

This was a case of unilateral TMJ ankylosis in a 22 year old girl. She was not able to open her mouth even for taking food for past 20 years. Her upper front teeth were completely decayed and broken. 3DCT scan shows TMJ bony ankylosis on the left side.

Maxillofacial Surgeon Dr. S. M. Balaji planned to open her mouth by following gap arthroplasty with temporalis muscle interpositioning. Under GA, Al-Kayat-Bramley’s incision (Preauricular incision) was made on the left side; a superior limiting cut was made along the demarcation between the rim of the glenoid fossa and the ankylosed head. The ankylotic mass was removed. After ressecting the callous, the gap was further widened by removing adequate bone.

On the left side, the temporalis muscle was rotated and folded inwards into the joint cavity and taken between the medial surface of the ramus taking good care of the adjacent mandibular nerve, facial and maxillary arteries. Then the muscle end was sutured to the medial side of the mandible to provide a submandibular anchorage. A suction drain is placed for 24-36 hrs and the wound was closed in layers. Results are immediate and mouth opening of width up to 44mm was achieved. Patient is put on post surgery physiotherapy to maintain the mouth opening.

Preoperative 3DCT scan showing fused left condyle with that of the cranial base

Inability to open the mouth due to fused condyle on the left side

Preauricular approach to expose the fused joint and cut was made to release the bony fusion

Temporalis muscle interpositioning was done to maintain the movement of the joint

Immediately after relieving the ankylosis mouth opening upto 42mm is achieved

Augmentation rhinoplasty for saddle nose defect

23/1/2015

A 30-year-old man reported to our hospital seeking to correct the appearance of his nose. His nose was much flat in the middle portion 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 dorsum of the nose. The surgery was done from inside the nose (closed rhinoplasty) so there is no scarring. The patient is very happy to have a sharp, defined & pristine nose immediately after surgery, which improved his appearance.

Preoperative facial view showing broad flat depressed dorsum of the nose

Depressed dorsum of the nose giving asymmetric profile view

Harvested costochondral graft placed on the dorsum of the nose

Augmented dorsum of the nose intranasally using costochondral graft giving enhanced appearance

Postoperative profile view showing augmented dorsum of the nose

Successful isolated cleft palate repair surgery

21/1/2015

A 6 month 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 positive suction test was achieved.

Isolated cleft palate in 6 months old baby boy

Cleft palate closure done using palatal pushback technique

Suction test - positive

Successful removal and reconstruction of huge cystic lesion of mandible

19/1/2015

A 22 year old boy reported to our hospital with the complaint of swelling with pain in left side of face. He added that the swelling was progressive and had occasional fluid discharge inside his mouth.

After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as odontogenic keratocyst (OKC) involving the left side of the mandible. Dr. Balaji has planned to remove the entire cystic lesion along with the lining and reconstruct the same in a single surgery. Intraorally, mucoperiosteal flap was raised and the cystic lesion was exposed. Infected cyst along with the lining and involving bone was removed in toto. For reconstruction of the mandible, costal graft was harvested from the ribs and stainless steel reconstruction bone plate was used. The mucosal flap was approximated in layers.

Preoperative digital orthopantomogram showing huge multilocular cystic lesion involving the entire left side of the mandible

Preoperative 3DCT scan view showing complete bony destruction on the left side of the mandible

Intraoperative view showing removal of the diseased portion of the mandible in toto

Costal graft harvested from the rib cartilage for the reconstruction of the mandible

Reconstruction stainless steel bone plate and costal graft aligned to the shape of the mandible

Harvested graft fixed with the excisting mandibular segment

Immediately after suturing the soft tissues

Flat nose correction without any scars

13/1/2015

A 20-year-old girl reported to our hospital seeking to correct the appearance of her nose. Her nose was much flattened in the middle and she wanted to have a sharp nose to improve her 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 her appearance.

Flattened dorsum of the nose .

Harvested costochondral graft used to augment the dorsum of the nose

Immediate postoperative view showing augmented dorsum of the nose giving pristine look without any scars

Cosmetic nose correction for broad flattened nose without any scars

9/1/2015

A 25 year old male reported to our hospital with the complaint of depressed nasal bridge and broad base of the nose.

Maxillofacial Surgeon Dr. S.M. Balaji corrected his nose by following Augmentation Rhinoplasty technique. Cartilage graft has been harvested and sculpted for the correction of depressed nasal bridge. 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.

Preoperative facial view showing broad, flattened nose with ill defined nasal bridge

Preoperative profile view showing depressed dorsum of the nose giving saddle like appearance

Intra operative view showing harvested costochondral graft placed on the dorsal surface of the nose to show the dorsal defect

Immediate postoperative view showing augmented dorsum of the nose giving pristine look without any scars on the face

Postoperative profile view showing augmented nasal bridge giving enhanced profile view

Successful cleft nose and lip correction with Abbe flap

7/1/2015

A 22 year old boy born with bilateral cleft lip and palate came to our hospital for expert cleft treatment. He was operated elsewhere for primary cleft lip and palate. He had a thin upper lip and broad flattened nose for which he sought treatment.

Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, the flap will be divided giving the upper lip a more natural, improved form.

Simultaneously, the broad nose was reshaped to make them more proportionate and balanced. Following surgery, the nose appeared sharp & defined with more proportionate profile.

Preoperative facial view showing defective cleft nose and lip

Preoperative profile view showing depressed nasal tip due to missing columella and missing upper lip prominence

Immediately after Abbe division showing enhanced appearance of nose and upper lip without much surgical marks

Profile view showing augmented nose profile and columella and proportionate lips were obtained giving enhanced appearance

Successful treatment of lower jaw fractures sustained in a vehicular accident

5/1/2015

A young man had met with a motor vehicular accident few weeks back in which he had sustained injuries to his lower jaw. He had severe jaw pain and he had great difficulty in biting, chewing, and swallowing.

A preoperative 3D CBCT scan revealed fracture in the right mandibular parasymphysis region and left angle of mandible. Maxillofacial Surgeon Dr. S.M. Balaji successfully fixed and stabilized the fractured segments using stainless steel bone plates and screws. Extreme care was taken to save the mental nerve, since fracture was very close to that of the mental foramen. Accurate occlusion and bite was achieved. Post surgery radiograph showed optimum fracture fixation.

Preoperative digital orthopantomogram showing fractured mandible - right parasymphysis and left angle region

3D CBCT scan showing fracture in right parasymphysis region of the mandible

3D CBCT scan showing fracture in left angle of the mandible

Intraoperative view showing fracture fixation in right side of mandible also protecting the mental nerve from getting caught into fracture line

Fracture fixation in the left angle of the mandible

Postoperative radiograph showing successful fixation and stabilization of fractures immediately after surgery

Cosmetic rhinoplasty - bend nose correction without any scars

5/1/2015

This is a case of deviated nasal septum and depressed dorsum of the nose. Maxillofacial Surgeon Dr. S. M. Balaji cosmetically corrected the deviated nose by closed rhinoplasty technique. Deviated nasal septum was straightened and dorsum of the nose was augmented by costochondral autograft obtained from the rib cartilage. Postoperative view enhanced her facial appearance by having pristine nose profile. She was very happy to have the entire nose correction without any scars.

Deviated nasal septum with depressed dorsum of the nose

Corrected nasal septal deviation and augmented dorsum of the nose without any scars on the face

Correction of defective upper jawbone with internal maxillary distraction osteogenesis

2/1/2015

This is a case of unilateral cleft lip and palate operated elsewhere. His profile view was asymmetric due to defective upper jaw bone which also developed difficulty in speech and chew foods. Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected the defective upper jawbone by using intraoral bilateral maxillary distraction osteogenesis technique following orthodontic treatment to have perfect occlusion postoperatively. Results are immediate and patient is very happy of his improved appearance and to have entire jaw correction done without any scars.

Preoperative profile view showing defective upper jaw due to cleft defect

Intraoperative view showing lefort I osteotomy with bilateral maxillary internal distractor fixed

Intraoperative view showing internal maxillary distractor fixation following orthodontic treatment

Postoperative view following internal maxillary distraction osteogenesis giving enhanced appearance