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Cleft Lip surgery: good long-term results

28/2/2014

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Baby girl from Kolkata with unilateral cleft lip and palate
Immediately after suture removal following primary cleft lip surgery
Improved appearance with minimal scarring few weeks after surgery
A baby girl from Kolkatta, born with unilateral cleft lip & palate, was brought to our hospital by her parents for cleft surgery. The baby was successfully operated for primary cleft lip by Maxillofacial Surgeon Dr. S.M. Balaji. Photographs taken over the following weeks show good results with minimal scarring. The baby’s appearance, feeding & overall health has improved considerably.
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Successful Secondary Cleft Lip repair

27/2/2014

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Secondary cleft lip defect
Reconstruction of upper lip
Enhanced, scarless appearance few days after surgery
A man reported to our hospital with a history of bilateral cleft lip and palate repair done elsewhere during his childhood. He now sought to correct his secondary lip defect to improve his appearance.

The middle part of his upper lip was very thin and scarred. Maxillofacial Surgeon Dr. S.M. Balaji skillfully rearranged the soft tissues of his upper lip giving it a more ideal form and correcting the defect. Following surgery, the normal shape & form of the lip was restored without any unsightly scars. The man was overjoyed to get a more attractive appearance. 




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 Pharyngoplasty surgery for speech correction in cleft patient

26/2/2014

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A 23-year-old female previously operated elsewhere for bilateral cleft lip & palate, reported to our hospital with a complaint of nasal twang in her speech. Cleft afflicted patients usually have a nasal sounding speech. This condition, called velopharyngeal incompetence or nasal escape of air while speaking, can be surgically corrected.

Maxillofacial Surgeon Dr. S.M. Balaji performed a dynamic sphincter pharyngoplasty surgery wherein the palato-pharyngeal muscles were criss-crossed to correct the velopharyngeal incompetence. The video shows the new dynamic velopharyngeal sphincter.
Velopharyngeal incompetence causing nasal twang in speech in cleft patient
Criss-crossing of palatopharyngeal muscles
Dynamic sphincter pharyngoplasty surgery
Surgical correction of velopharyngeal incompetence
Immediately after surgery- new dynamic velopharyngeal sphincter
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Successful reconstruction surgery for abnormally wide mouth

26/2/2014

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Child with Macrostomia or abnormally large mouth
Reconstruction using vermillion return flap technique
Surgical correction of Macrostomia
During surgery
Immediately after surgical reconstruction
Scarless appearance few months after surgery
A boy born with macrostomia was brought to our hospital by his parents, for surgical correction. Macrostomia is a rare type of facial cleft deformity in which the mouth is unusually wide.  Normally, the angle of the mouth approximately aligns with a line drawn from the pupil of the eye. In this case, the mouth was abnormally wide causing a gross distortion of the child’s appearance.  

Surgical correction of macrostomia is challenging & complex as it aims to restore appearance while at the same time maintain normal functions like speech, eating & blowing. Maxillofacial Surgeon Prof. S.M. Balaji skillfully reconstructed the mouth by approximation of the facial muscles. The defect was closed in layers to reconstruct a natural-looking & symmetric mouth & lip length, height & contour using the Vermillion return flap technique.

Following surgery, there was no scarring. The boy’s appearance improved dramatically and functions of the face muscles are normal.



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Successful jaw reconstruction & dental implants for African boy

25/2/2014

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Multiple missing teeth in a boy suffering from Ectodermal Dysplasia
X-ray before surgery
Failed bone graft done elsewhere
Harvested rib graft fixed to upper jaw bone
Lower jaw bone strengthened with rib graft
rhBMP-2 placed in lower jaw bone
rhBMP-2 will stimulate the body's own cells to form new bone
rhBMP-2 placed in upper jaw bone
X-ray taken just after jaw reconstruction & implant surgery
A young African boy from Nigeria suffering from Ectodermal Dysplasia was referred to our Hospital for expert care. He had multiple missing teeth & had previously undergone bone grafting elsewhere but the graft had already resorbed & failed.

Maxillofacial Surgeon Prof. S.M Balaji performed the complete jaw bone reconstruction using rib graft & rhBMP-2. Implants were placed to replace his missing teeth. Following osseointegration of the implants, ceramic prosthesis will be given.
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Rare case of maxillary and mandibular fusion with TMJ ankylosis

21/2/2014

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A 13 year old boy from Karur, reported to our Hospital with a rare condition of bony fusion of the upper and lower jaws along with fusion of left TMJ (Jaw Joint) with base of the skull since birth. Maxillofacial surgeon Dr. S.M. Balaji performed the reconstructive surgery wherein the fused jaws were surgically separated, raw areas were covered with mucosal tissue and maximum mouth opening was achieved.

The boy requires follow-up physiotherapy exercises to retain the corrected mouth opening and prevent recurrence of the condition.
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Good aesthetics following Lipoma removal without scarring

20/2/2014

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Lipoma just above right eye affecting facial appearance
Surgical removal through a small incision
Negligible scar following surgery
Improved appearance following cosmetic correction
A young female reported to our hospital with a complaint of an unsightly growth just above her right eye. Though painless, it affected her appearance and she wanted to remove it without causing any scars.

On examination, the growth was diagnosed to be lipoma. These are benign growth of fat cells, which are usually painless & soft, rubbery in texture, requiring surgical removal.  Maxillo-facial Surgeon Dr. S.M. Balaji employed a very small incision to remove the lipoma entirely. Due to his precision & skill, there was no scarring following surgery & the patient was very happy with her improved appearance.
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Bangladeshi boy gets his right & left lower jaw reconstructed

19/2/2014

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X-ray showing multiple cystic tumors of jaw
Graft harvested from rib
Tumor portion of right lower jaw excised
Left lower jaw affected with cystic tumor surgically removed
Excised portion of left lower jaw
Excised portion of right lower jaw
Rib graft used to reconstruct ressected portion of jaw
Complete lower jaw reconstruction using the grafts
rhBMP-2 placed in lower jaw
rhBMP-2 stimulates body's own cells to form new bone
Immediately after lower jaw reconstruction surgery
A 14-year-old boy from Bangladesh with multiple cystic tumors of the jaws reported to our hospital for specialized treatment. Radiographic investigations showed multiple, extensive cystic tumors on both right & left side of the jaws. Histopathological examination confirmed odontogenic keratocysts. Maxillofacial Surgeon Dr. S.M. Balaji surgically excised the tumor portions of the both sides of the lower jaw. Complete lower jaw reconstruction was done using rib graft and rhBMP-2 which stimulates the body’s own cells to form new bone.  




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Secondary cleft nose correction for improved esthetics & function

17/2/2014

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Cleft nose deformity before surgery
Cartilage graft shaped to form the framework of nose
Nose reshaped using grafted cartilage
Improved aesthetics & function following cleft rhinoplasty
A young man born with unilateral cleft lip and palate reported to our hospital seeking expert correction of his nose deformity. Lower lateral cartilage on the cleft affected side was buckled & depressed affecting his appearance and breathing. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the secondary cleft rhinoplasty or nose correction procedure employing a cartilage graft. The structural framework of the nose was defined using the graft giving the nose a symmetric, aesthetic form. Following surgery, the overall facial profile and breathing improved remarkably.   

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Earlobe reconstruction using Limberg flap

16/2/2014

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Appearance of left ear deformity
Limberg flap raised
Earlobe reconstruction using Limberg flap
Good results immediately after earlobe reconstruction
A 22-year old female born with a deformed ear, sought the expertise of Maxillofacial Surgeon Dr. S.M. Balaji for reconstruction of her left earlobe. Previously, in some other hospital elsewhere, multiple attempts to reconstruct the ear were done but she was not satisfied with the results.

Dr. Balaji employed the Limberg flap to successfully reconstruct the earlobe. In the next surgery, ear helix reconstruction with costal cartilage will be done. 

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Orbital Tumor excision with Lateral Canthotomy

14/2/2014

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Young boy with tumor of right eye
During surgery-orbital tumor exposed
Orbital tumor excision with lateral canthotomy
More normal appearance immediately after tumor removal surgery
Immediately after tumor removal & suturing done
A 15-year-old boy suffering from a rare tumor of the right eye was brought by his parents to our hospital for specialized care. Through a lateral canthal incision, the orbital tumor was excised. The incision and wound was sutured. 

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Bilateral Cleft Lip- Successful Primary Correction

12/2/2014

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Baby girl born with bilateral cleft lip & palate
Facial appearance of cleft baby before surgery
Immediately after primary cleft lip correction
Immediately after primary cleft lip correction
A 5-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.

Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance.  Subsequent cleft palate surgery will be done to completely rehabilitate the child. 

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Abbe-Flap technique for secondary lip correction

11/2/2014

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Secondary cleft defect in upper lip
Abbe flap technique-Flap taken from lower lip & sutured to defective upper lip
After lip correction with abbe flap and cleft nose correction
A boy born with bilateral cleft lip and palate & operated elsewhere reported to our hospital with his parents seeking specialized treatment for his secondary lip defect. The central part of his upper lip was very thin and scarred and his nose also appeared deformed.

Maxillofacial surgeon Dr. S. M. Balaji performed a combined procedure to correct nose and lip defect in a single surgery. Upper lip reconstruction was done using Abbe-Flap. The upper lip defect was measured; a flap of tissue of exactly same size was taken from the lower lip and sutured together with the upper lip with the base of the flap still attached to the lower lip to maintain the blood supply. After 14 days, the flap was divided and normal form and function were restored in the upper lip. Nose correction was also done in the same surgery. The boy and his family are very happy with the enhanced appearance & absence of scars.

                                             

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