A 15 year old boy with unilateral cleft lip and palate reported to our hospital with the complaints of slurred speech. Cleft lip, palate correction and bone grating were done in their hometown during his childhood. He gave the history of flap pharyngoplasty done elsewhere 1 year back. 

Maxillofacial surgeon Dr. S. M. Balaji skillfully diagnosed and concluded that his defective speech was due to Velopharyngeal incompetence by abnormal suturing of soft palate muscle. Thus he expertly planned to correct his speech by re positioning the pharyngeal muscles in such a way, soft palate movement will be enhanced and dynamic sphincter will be created. Thus re pharyngoplasty was performed successfully and suction test was done after the procedure which indicates positive results due to excellent soft palate movement enhancing the sphincter muscle activity. Immediate results were shown in the following video.  

VIDEO: Intra oral video after surgery showing suction test positive thus dynamic sphincter created

A 29-year-old man from Singapore reported to our hospital seeking expert treatment for his widely spaced upper right teeth due to which there was food impaction problem & caused an aesthetic concern. Also his upper right teeth were mobile which made it very difficult to bite & chew food. 

Digital X-ray taken showed bone loss in the region of upper right incisor, canine & first premolar that caused mobility of the teeth. Maxillofacial Surgeon Dr. S.M. Balaji performed the jaw bone reconstruction. The periodontally weakened teeth were extracted and implants placed. A symphysis bone graft was harvested from the lower jaw chin region & placed in the bone deficient region of the upper jaw to compensate the bone deficiency. The surgical site was sutured. Crown prosthesis will be given later to completely replace his missing teeth. 

A 20 year old girl reported to our hospital wanting to correct her gummy smile. Also her protruding lower jaw affected her appearance. She had low self-esteem & she wanted to enhance her looks. She had already consulted many dentists and had braces for 3 years elsewhere, but she was not satisfied with the results. Her parents too were anxious to correct her smile and enhance her facial appearance before getting her married.

Maxillofacial Surgeon Dr. S. M. Balaji expertly planned for simultaneous correction of her both upper and lower jaw. Surgical correction of gummy smile was done with Le Fort I osteotomy to reduce the maxillary excess bone. Protruding lower jaw was set back intra orally with sagittal split osteotomy. Post operatively her appearance improved greatly & instantly due to excellent profile correction. She & her parents were very happy with the immediate results & that the jaw correction surgery was done without any scars on the face. 

An 18 year old boy reported to our hospital with the complaints of severe pain and swelling in the left side of his face. Intraorally, a bone plate was exposed and huge infection with pus discharge adjacent to the exposed plate region was noticed.  He gave a history of odontogenic keratocyst (OKC) in the left side of the lower jaw which was removed elsewhere and reconstructed with bone graft and bone plate twice, 1 year back. His parents were frustrated due to repeated surgeries.

Maxillofacial Surgeon Dr. S. M. Balaji adroitly planned to remove the infected bone graft and plate and to reconstruct the lower jaw in a single surgery. He approached the surgical site extraorally through the previous scar region and removed the dislodged bone plate and sequestrum completely. Adjacent infected bone was removed with bone curette and a new NiTi bone plate was fixed to the adjacent healthy bone. To enhance the rigidity, costal graft was harvested and placed near to the bone plate with rhBMP-2 to increase the efficiency of new bone formation. Mucosal flaps were approximated in layers with very minimal scar formation. 

Post operative X-ray taken after 3 months revealed good amount of healthy bone formation maintaining the contour of the mandible using bone plate.

A 4-month old baby girl born with unilateral cleft lip & palate was brought to our hospital by her parents seeking the best treatment for cleft defect.

Maxillofacial Surgeon Dr. S.M. Balaji performed the primary repair surgery for unilateral cleft lip using Modified Millard’s technique. Following surgery, the baby’s appearance improved greatly and she was able to feed well. The parents were very happy that their baby had hardly any post-surgical scars. Consecutively cleft palate correction surgery will be done.

A 3 month old baby boy born with unilateral cleft lip and palate was brought to our hospital by his parents for surgical rehabilitation of cleft deformity.

Maxillofacial Surgeon Dr. S. M. Balaji performed the primary cleft lip repair using Modified Millard’s technique. His parents were very happy that their boy’s lip defect was corrected with very minimal scar and the appearance improved greatly. The baby with his family went back to their home place and they are to return for further cleft management.

A girl born with unilateral cleft lip and alveolus defect along with macrostomia was brought to our hospital by her parents for surgical correction. Macrostomia is a rare type of facial cleft deformity in which the mouth is unusually wide. In this case, the girl had both alveolar cleft defect and abnormally wide mouth causing a gross distortion of her facial appearance. 

Maxillofacial Surgeon Dr. S.M. Balaji skillfully corrected the alveolar cleft defect and macrostomia in a single surgery. Alveolar cleft defect was closed with miracle protein rhBMP-2 and macrostomia was corrected by approximating the adjacent facial muscles. The defect was closed in layers and the lip was made more natural by maintaining the height and contour using the vermillion return flap technique. 

The girl’s parents felt very happy as both large mouth and cleft repair surgery was combined and post operatively scars were very less. 

A 10-year-old boy was brought to our hospital seeking specialized correction for his lip defect. They gave a history of the boy having undergone treatment elsewhere for hemangioma of both upper & lower lip. The lesion had been removed but the lip was not reconstructed properly. The thin & disproportionate upper lip caused difficulty in pronouncing certain words and also his appearance was affected.

Maxillofacial Surgeon Dr. S.M. Balaji performed the lip reconstruction surgery. The bulky lower lip was skillfully reduced and thin upper lip was corrected by increasing the fullness from the adjacent region without any graft. Thus the newly reconstructed lip was blended naturally with very minimal scars. This surgery improved his appearance and his pronunciation better. This made his parents feel very happy. 

An 8 year old boy with bilateral cleft lip and palate defect from Mumbai was brought to our hospital with his parents for closure of the cleft defect in the teeth bearing region of upper jaw bone and further rehabilitation of his cleft deformity. The primary cleft lip and palate repair was done elsewhere.

The premaxilla was separated from rest of the alveolus which can be clearly appreciated in 3D CBCT scan. Thus upper alveolus was separated into three different parts which will severely affect the development of teeth later.

Maxillofacial Surgeon Dr. S. M. Balaji performed the premaxillary setback procedure with rhBMP-2 which helps in uniting the three parts into a single jaw bone with new bone formation. This surgery helped for proper growth and development as well as alignment of his teeth.

Sixteen years ago, a 4-month-old baby girl born with unilateral cleft lip & palate was brought to our hospital by her parents for the complete rehabilitation of her cleft deformity. Maxillofacial Surgeon Dr. S.M. Balaji performed the successive surgeries over the years.

Primary cleft lip repair surgery was done when the baby was 4 months old and palate repair surgery was done at 8 months of age. When the baby was 6 years old, rhBMP-2 surgery was done to treat the alveolar cleft defect. Miracle protein rhBMP-2 was placed in the cleft of the teeth bearing region of the upper jaw to completely heal the bony defect avoiding bone graft.

Now the girl reported to our hospital seeking to enhance her facial profile. She had a hypoplastic maxilla (retruded upper jaw) and she was not happy with her appearance. Dr. Balaji performed the intraoral maxillary distraction osteogenesis whereby the upper jaw was advanced and aligned properly with the lower jaw. This was done completely inside the mouth so there were no scars. Using distraction & orthodontics, her appearance & facial profile was greatly enhanced.  

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 baby boy born with isolated cleft palate defect was referred to our hospital for surgical correction of the cleft defect.

Maxillofacial Surgeon Dr. S.M. Balaji performed the cleft palate repair using Palatal pushback technique. The palatal flap was raised on both right & left side. The palate muscles were reattached in their normal position & a two layer closure was done to completely reconstruct the floor of the nose and roof of the mouth. The suction test was positive which guarantees good speech.

An 8-month-old baby girl from Africa, born with unilateral cleft lip & palate, was brought to our hospital by her parents for the surgical correction of her lip defect.

Maxillofacial Surgeon Dr. S.M. Balaji performed the primary lip repair surgery using the Modified Millard’s technique. The baby’s parents were very happy that their baby’s lip defect was corrected with hardly any scars and the child’s appearance greatly improved.  The baby and her family went back to her homeland and they are to return later for further cleft management. 

An 8-year-old boy was brought to our hospital by his parents for surgical correction of his cleft defect. His cleft lip and cleft palate defect was operated elsewhere, in his childhood. The surgery results were adverse as the entire pre-maxilla was removed.

Maxillofacial Surgeon Dr. S.M. Balaji performed the alveolar cleft repair using rhBMP-2 avoiding bone grafting. Miracle protein rhBMP-2 is a bioengineered version of a protein that occurs in the body. When placed in the cleft defect, it stimulates the body’s stem cells to form new bone and thereby healing the bony defect in the teeth bearing region of the upper jaw. By using rhBMP-2, bone graft surgery from the hip or rib is avoided, thereby avoiding an additional surgery & unsightly scars. 

A 32-year-old man came to our hospital seeking treatment for his extreme inability to open his mouth normally. Preoperatively, his mouth opening was just 11 mm. He gave a history of cigarette smoking and pan chewing for 2 decades. He was diagnosed with Oral submucous fibrosis, a condition characterized by thickening of the mucosal tissues and progressive rigidity of the jaws making it exceedingly difficult to open the mouth. Previously he underwent laser surgery elsewhere, 3 times, for this ailment but it did not work. 

In the surgical treatment procedure, Maxillofacial Surgeon Dr. S.M. Balaji placed transverse incisions on the cheek on both right & left side to release the fibrous bands and to immediately improve the mouth opening. An inferiorly based Nasolabial island flap based on the facial artery was raised and transposed intraorally through a small trans-buccal tunnel. This was sutured with the buccal mucosal defect. Extraorally, the defect was closed in layers. Immediately following surgery, a normal mouth opening of 35 mm was achieved.

Nine-month-old Mohammed Altaf, from UAE, was born with incomplete cleft lip. His father & mother brought him to our hospital for specialized cleft care.

Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip repair surgery using Modified Millard’s Technique. Following surgery, there was very negligible scar on the upper lip and the boy’s appearance improved greatly. This made the boy’s parents feel very happy with the surgery success. 

A 35-year-old woman reported to our hospital seeking to enhance the appearance of her nose. Her nose was flattened and ill-defined making her very self-conscious about her appearance. She wanted to improve her facial profile.

Maxillofacial Surgeon Dr. S.M. Balaji performed a nose correction procedure called Augmentation Rhinoplasty. The nasal bridge was raised with a cartilage graft (costal cartilage). The surgery was done within the nose so there are no scars on the face. The woman’s nose was made sharp & pristine that greatly enhanced her appearance & profile. She was very happy to have a renewed confidence with a new, improved look.

A 28-year-old electrician came to our hospital seeking expert treatment for his face burn. He had suffered a severe burn injury to the left side of his face, in an accident at his workplace. Elsewhere, a split-thickness skin graft surgery from his thigh was done but the patient was very unhappy with the graft shrinkage and color mismatch.

Maxillofacial Surgery Dr. S.M. Balaji performed the facial reconstruction surgery using the novel “Tissue expansion” technique wherein a device called tissue expander was placed beneath the normal skin on the left cheek. Saline solution was infused into the device regularly. The device gradually expanded, stretching the overlying skin. New, healthy skin was grown at the site locally, of the same color & texture. This skin was used to reconstruct the scarred portion of the left cheek, chin & neck. Since the tissue was grown locally, there was no color mismatch. The wound healed well and his appearance improved drastically

Video showing saline being drained out from the expanded device before the device is removed

A 35-year-old man reported to our hospital seeking expert treatment for his lower jaw (mandible) fracture. He gave a history of having sustained the injury in a road traffic accident. He had sought various treatments elsewhere but the multiple surgeries were futile with non-healing results. 

A CT scan showed complete non-union of the fractured segments. Maxillofacial Surgeon Prof. S.M. Balaji performed the surgery for jaw fracture fixation. The fracture site was accessed and fibrous tissue as a result of non-healing of the fractured fragments was removed. The bone ends were freshened, proper occlusion was established, and the fractured fragments of the lower jaw were fixed with a 6-hole & 4-hole bone plate with 2 mm screws. A cortico-cancellous bone graft from the right hip region was harvested and packed into the fracture defect. The graft and bone ends were covered with a collagen sponge soaked in rhBMP-2. rhBMP-2 is a miracle protein that stimulates the body’s own cells to form new bone thereby ensuring complete healing of the bone defect. Following this, the wound was sutured.

A baby boy born with cleft lip & palate was previously operated by Maxillofacial Surgeon Dr. S.M. Balaji for primary cleft lip repair. The baby now 9 months old, was brought to our hospital by his parents for surgical correction of the cleft palate.

Dr. Balaji performed the cleft palate repair using Palatal pushback technique. Incision was made in the mid-vomerine region. The palatal flap was raised on both right & left side. The Levator palatine muscles were detached from their abnormally attached positions and reattached into 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. The vertical mattress sutures produce a ridge of thick mucoperiosteum as the flaps are approximated to each other in the midline. The suction test was positive which guarantees good speech.

A 6-month-old Sri Lankan baby boy, born with unilateral cleft lip and palate, was referred to our hospital for surgical correction of his cleft defect.

Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip repair surgery. Following lip correction, the baby is able to feed well and his facial appearance has improved greatly. In the near future, correction of his palate defect will be done for complete rehabilitation. 

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. 

A middle-aged man sustained severe injuries to his lower jaw in a road traffic accident. He was rushed to our hospital for emergency care & treatment.

A digital radiograph showed a fracture in his lower jaw in the front teeth region & a fracture of the right jaw joint. In the open reduction surgery performed by Maxillofacial Surgeon Dr. S.M. Balaji, the right jaw joint or temporomandibular joint was surgically exposed through a preauricular endaural approach. The condyle fracture segments were aligned in their normal position & fixed with bone plate. The fracture in the middle of the lower jaw was also fixed with bone plate. Subsequently, the fractures healed well.