Blog Archives

Complete facial rehabilitation after road traffic accident

30/3/2016

A 35 year old lady reported to my hospital with the complaints of facial disharmony due to road traffic accident happened 1 year back. She said first aid and fractured facial bone correction done in different hospital at her home town. But the outcome of the surgery was not satisfactory. She wanted to correct her face without much scars on her face.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji planned to correct her face in a single surgery without any scars on her face. Intraorally, maxilla was advanced by Le Fort I osteotomy and mandibular bone plate was removed. Using bicoronal flap the frontal bone correction was done and orbitoparietal portion of skull and glabella depression was augmented using costochondral rib graft. Depressed dorsum of the nose was also augmented using costochondral rib graft. Superior orbital rim was also augmented using rib graft. Thus entire facial rehabilitation was done without any visible scars on the face. Patient and her family were very happy to see her facial transformation.

Preoperative 3DCT scan showing panfacial fracture

Complete midface deficiency due to trauma

Frontal bossing and depressed glabella

Profile view showing depressed dorsum of nose and retruded maxilla

Defective nose with depressed glabella and frontal bossing

Incorrect bite due to fractured maxilla and mandible

Costochondral rib graft harvested to correct the facial bone defects

Intraorally Lefort I maxillary advancement done

Bicoronal flap raised and frontal bone elevated

Isolated frontal bone

Dr. S. M. Balaji operating on the patient

Frontal bone was trimmed to correct the bossing

Prepared Frontal bone

Approximated frontal bone and augmented supraorbital rim and glabella using rib graft and rhBMP2 protein

Immediate postoperative view showing enhanced facial appearance without any visible surgical marks on the face

Postoperative frontal view showing enhanced forehead and eye socket with corrected nose shape without any scars on the face

Postoperative profile view showing augmented root and base of nose with pristine tip without any scars on the face

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Augmentation rhinoplasty for saddle-shaped nose

19/3/2016

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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, slants and abnormally angled noses. The patient’s expectation of his/her nose is understood after careful examination.
Shown is a case with of a deficiency of the bridge portion of nose with bulky tip. 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. 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 tip of the nose was also corrected intranasally by removing excessively curved lower lateral nasal septal cartilage. The patient was very happy with the surgery outcome and her enhanced appearance.

Preoperative facial view showing depressed dorsum of nose with bulky tip

Profile view showing saddle nose appearance

Bulky tip of the nose with depressed dorsum of nose

Immediate postoperative view showing augmented dorsum without any visible surgical marks on the face

Augmented dorsum of nose

Corrected tip of the nose without any visible surgical marks on the face

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Thick facial scar adhered to underlying bone corrected for enhanced appearance

15/3/2016

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This is a case of huge dermal scar revision. Due to road traffic accident the patient had a skin abrasion 5 months back. He was very unhappy due to a depression in the lower jaw and upper neck region on the left side with absence of hair growth in the affected region, and a thick scar that was adherent to the underlying bone, which was affecting his appearance. He wished to have the complete scar revision to enhance his facial appearance.
Maxillofacial Surgeon Dr. S.M. Balaji successfully removed the thick scar tissue which was strongly adherent to the underlying bone. The depression was reconstructed by the mobilization of platysma and skin by following double layer closure. The patient was happy that his appearance was greatly improved.

Preoperative view showing thick scar adherent to the underlying bone

Intraoperative view after complete removal of scar tissue and platysma flap mobilized and raised

Platysma flap used to cover the bone and reconstruct the depression

Immediately after double layer closure

Postoperative view immediately after suture removal following seven days of surgery

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Successful removal of huge dentigerous cyst in lower jaw along with the impacted canine tooth and reconstruction

4/3/2016

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A 27 year-old man came to our hospital with a complaint of swelling with pain in his lower jaw. A digital X-ray took revealed a large cystic lesion extending from premolar to premolar of the mandible with complete erosion of the labial plate and impacted canine tooth.

Histopathological examination of the specimen showed it to be a dentigerous cyst. Maxillofacial surgeon Dr. S.M. Balaji expertly removed the entire cystic lesion along with the lining with affected tooth in toto. Defective portion of the lower jaw was reconstructed using costochondral rib graft and bone protein rhBMP2. Following surgery the wound healed well and the patient was happy to be cured of his ailment.