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

Successful cleft nose and lip correction with Abbe flap

25/3/2015

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

Costochondral rib graft harvested to reconstruct the defective cleft nose

Immediately after suturing

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

Combined nose and jaw correction for enhanced appearance

16/3/2015

A young man came to our hospital wanting to correct the shape of his broad, bulky nose that gave his face an unattractive appearance. Also his lower jaw was severely protruding making it difficult for him to bite, chew and speak well. He wanted to correct his jaw defect also.

Maxillofacial Surgeon Dr. S.M. Balaji performed a combined nose correction and jaw correction surgery. The large bulky nose was reduced and made more proportionate and sharp with reduction rhinoplasty. Using Obwegeser’s sagittal split osteotomy the protruding lower jaw was set back and into proper alignment with the upper jaw thereby correcting his bite. Nose and jaw correction was done from inside the nose and mouth respectively so there were no scars. The man was very happy that his appearance improved greatly and that both his nose and jaw defect were corrected simultaneously.

Preoperative view showing broad nose with bulky nose tip

Incorrect bite before surgery due to disproportionate and protruding lower jaw

Improved postoperative view following reduction rhinoplasty without any scars on the face

Accurate bite after corrective jaw surgery

Successful reconstruction of alveolar cleft into a single jaw bone using miracle bone protein rhBMP-2

9/3/2015

A 3 year old boy with unilateral cleft lip and palate defect from Bihar was brought to our hospital by his parents for closure of the cleft defect in the teeth bearing region of upper jaw bone. He was previously operated for cleft lip and cleft palate. Due to the cleft defect, upper alveolus was in two parts which will severely affect the development of teeth later.

Maxillofacial Surgeon Dr. S. M. Balaji performed the cleft alveolus closure with rhBMP-2 which helps in uniting the two 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 later.

Preoperative intraoral view showing alveolar cleft defect in left side

Preoperative digital orthopantomogram showing cleft alveolus in left side

Intraoperative view showing alveolar cleft after raising gingivomucoperiosteal flap

rhBMP-2 placed in the alveolar cleft region to induce new bone formation

Immediately after suturing

Cosmetic Rhinoplasty for bulky nose without scars

8/3/2015

A 21-year-old girl reported to our hospital seeking to correct her large, bulky nose which greatly affected her facial appearance. She was very much disappointed as her nose profile was disproportionately flat and bigger due to the broad dorsum of her nose.

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the corrective rhinoplasty technique. Width of the nose was reduced by lateral osteotomy technique. Caudal portion of nasal septal cartilage was trimmed to reduce the bulky nose tip. Thus nose was made sharp and pristine and entire surgery was done from inside the nose to avoid any scars on the face (closed rhinoplasty technique). The patient was very happy to have a narrower, shapely nose that enhanced her facial profile with absolutely no scarring.

Broad flat nose with bulky nose tip

Lateral osteotomy

Caudal portion of nasal septal cartilage trimmed

Pristine nose without any scars

Successful removal and reconstruction of huge cystic lesion of lower jaw

6/3/2015

A 32 year old man reported to our hospital with the complaints of swelling in the lower half of the face. He also said that this swelling was there for a very long period with occasional numbness.

After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as odontogenic keratocyst (OKC) involving entire body of the mandible on both right and left side. He planned to remove the entire lytic lesion and reconstruction of the affected portion of the mandible in the same surgery. Costochondral graft was harvested from the ribs to reconstruct the mandible. Through intraoral approach, after raising gingivomucoperiosteal flap extending distally, the entire lesion along with the affected portion of mandible was removed in toto. Harvested rib graft was used to reconstruct the defective region of mandible. Patient is very happy to have both removal of lesion and reconstruction of the affected portion of mandible in the same surgery.

Digital orthopantomogram showing huge osteolytic cystic lesion involving the entire body of the mandible with many impacted supernumerary teeth

Preoperative 3DCT scan view showing osteolytic lesion involving the entire body of mandible

Costochondral rib graft harvested to reconstruct the affected portion of mandible

Intraoperative view where the cystic lesion was exposed and multiple impacted teeth were seen

Complete removal of cystic lesion with the lining

Cystic lining and multiple impacted supernumerary teeth and mandibular teeth removed in toto

Reconstruction of the affected portion of mandible with costochondral rib graft

Immediately after suturing

Successful primary lip repair for unilateral cleft lip and palate baby boy

4/3/2015

A 3-month-old baby boy born with unilateral cleft lip and palate was brought to our hospital his parents for specialized treatment of the defect.

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the primary cleft lip repair using modified Millard’s technique. Results are immediate. The baby’s appearance was remarkably improved and was able to feed well. His parents were very happy to have the cleft lip surgically treated with negligible scar. After few months cleft palate repair will be done.

Unilateral cleft lip and palate in a 3 months old baby boy

Intraoral view showing complete cleft involving entire palate

Primary cleft lip repair following modified Millard's technique

Immediately after suture removal following seven days of surgery showing enhanced appearance

Improved mouth-opening following facial reconstructive surgery for Oral Submucous Fibrosis

2/3/2015

Below is the case of a patient posted earlier who was afflicted with oral submucous fibrosis. He had severely restricted mouth-opening. Maxillofacial surgeon Dr. S.M. Balaji successfully performed the facial reconstruction surgery to improve his mouth-opening.

http://blog.smbalaji.com/surgery-of-the-week/oral-submucous-fibrosis

We are updating the post with recent postoperative photograph showing increased mouth opening following few weeks after surgery. The patient is very happy that he is able to open his mouth easily and normally.

Severely limited mouth opening before surgery

Fibrous bands released on left & right cheek to improve mouth opening

Nasolabial island flap based on facial artery raised & transposed intraorally on both sides

Flaps sutured with the buccal mucosal defect on right & left side

Following surgery, normal mouth opening achieved with minimal scarring

Postoperative view showing increased mouth opening and enhanced healing following few weeks after surgery

Fixation of 6 months old malunited fracture of right cheek bone intraorally to avoid scar formation

2/3/2015

A 20 year old boy came to our hospital with the complaint of fractured facial bone on the right side due to vehicular accident 6 months back. He was complaining of facial asymmetry due to posterior displacement of fractured cheek bone.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S.M.Balaji diagnosed fractured and malunited right body of zygoma. This led to facial asymmetry. To avoid scar formation, intraorally through sulcular incision wrongly united zygoma was exposed, refractured, elevated and fixed using 4 hole titanium bone plate. This improved his appearance dramatically. Patient was very happy to have fractured facial bone fixation without any surgical marks.

Preoperative 3DCT scan showing right body of zygoma fracture

Preoperative 3DCT scan showing fractured and malunited right body of zygoma

Fractured zygomatic bone exposed intraorally through sulcular incision

4 hole titanium bone plate was used to fix the refractured segments into its normal position