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Successful removal and reconstruction of huge osteolytic cystic lesion of lower jaw without any scars

14/3/2017

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​30 year old women reported to our hospital with the complaints of swelling in right side lower half of the face. She also said that this swelling was there for a very long period with occasional numbness in the right side of the face.
After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as odontogenic keratocyst (OKC) involving right body and ramus of the mandible. He planned to remove the entire lytic lesion and reconstruction of the affected portion of the mandible in the same surgery. Costochondral graft was obtained 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 the entire lesion and reconstruction of the affected portion of mandible in the same surgery.
Preoperative 3DCT scan view showing erosion of the cortical bone with expansion of the body and ramus of mandible
Preoperative 3DCT scan view showing erosion of the cortical bone with expansion of the body and ramus of mandible - lingual side
Preoperative 3DCT coronal slice view showing impacted wisdom tooth with huge osteolytic lesion of left ramus of mandible
Preoperative digital orthopantomogram showing large osteolytic lesion involving entire right half of the mandible
Harvested costochondral graft used to reconstruct the mandible
Affected portion of jaw showing complete osteolysis with wide spread was removed in toto
Harvested costochondral graft used to reconstruct the huge defect
Immediately after suturing
Postoperative digital orthopantomogram showing complete reconstruction of the right side of mandible
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Cosmetic rhinoplasty for deviated nose without scars

13/3/2017

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22 year old men reported to our hospital seeking to correct his deviated nose which greatly affected his facial appearance. He gave a history of road traffic accident 2 years back where he had severe injury on the nasal bones. He was very much disappointed as his nose was completely deviated to the right side giving asymmetric facial appearance.
Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the cosmetic rhinoplasty. Vertically nasal septal cartilage height was trimmed by medial osteotomy to reduce the height of the nose. Deviation along with the width of the nose was reduced by lateral osteotomy technique. Thus deviated nose and size of the framework of the nose was corrected from inside the nose to avoid any scars on the face (closed rhinoplasty technique).
A balance between the nose shape and facial profile was achieved for a more pleasing appearance. The patient was very happy to have a narrower, shapely nose that enhanced his facial profile with absolutely no scarring. 
Facial photograph showing severe deviation of nasal bridge towards right side due to trauma
Lateral osteotomy done to correct the nasal bridge deviation
Medial osteotomy done to reduce the bulkiness of dorsum of the nose
Immediate postoperative view showing complete correction of nasal bridge deviation without any visible surgical marks on the face
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Facial asymmetry correction in hemifacial microsomia patient using simultaneous internal maxillomandibular distraction osteogenesis

12/3/2017

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A 22 year old girl reported to our hospital for the surgical correction of asymmetry over the left side of the face. Facial asymmetry may be present in cases of hemifacial microsomia, TMJ ankylosis or may have resulted following condylar fractures. This patient had a mandibular deficiency at the ramus level and deficiency measured almost 14 mm with a resultant occlusal cant.
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After thorough clinical and radiological examination Maxillofacial Surgeon Dr. S. M. Balaji planned to correct the facial asymmetry using internal distraction osteogenesis with maxillomandibular distractor. Paragingival incision was placed over the left angle region along the anterior border of ramus. Full thickness mucoperiostal flap was reflected buccally and bone exposed. The direction of the osteotomy cut and positioning of the distractor is the most important as it determines the vector of distraction and this determines the direction of the bone growth. The distractor device was positioned and fixed using screws. Osteotomy is then completed along the medial cortex. Distractor device was checked and wound closure done. Le Fort I osteotomy was completed in maxilla. After a latency period of 5 days, distraction at the rate of 1 mm per day was accomplished and facial asymmetry was successfully corrected. Patient feels very happy to have the facial asymmetry correction without any scars on the face.
Preoperative facial view showing reduced height of the face on the left side - hemifacial microsomia
Preoperative bite showing severe occlusal cant towards left side
3DCT view showing reduced ramus height on left side with entire mandibular shift
Reduced height of ramus of mandible on left side
Normal height of ramus of mandible
During surgical procedure, distractor device fixed to the outer surface of the ramus with correct orientation with the jaw
Lefort I osteotomy to separate the maxilla from base of the skull
After completion of distraction facial asymmetry corrected completely
3DCT showing the complete bone formation after 3 months following distraction
Corrected occlusal cant with enhanced bite
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Primary cleft lip repair for 3 months old baby boy with unilateral cleft lip and palate

12/3/2017

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A 3-month-old baby boy born with unilateral cleft lip and palate was brought to our hospital by his parents for specialized treatment of the cleft defect.
Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the primary cleft lip repair using modified Millard’s technique.  Right away after surgery the baby’s appearance was remarkable improved and he was able to feed well. His parents were very happy to have the cleft lip treated with negligible scar formation. After few months cleft palate repair will be done.
Preoperative view showing unilateral cleft lip and palate defect in a 6 months old baby girl
Immediately after cleft lip suturing using modified Millard's technique
Immediately after suture removal following seven days after surgery showing negligible scar
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Primary cleft lip repair for 6 months old baby girl with unilateral cleft lip and palate

7/3/2017

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A 4-month-old baby boy born with unilateral cleft lip and palate was brought to our hospital by his parents for specialised treatment of the cleft defect.
Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the primary cleft lip repair using modified Millard’s technique.  Right away after surgery the baby’s appearance was remarkably improved and he was able to feed well. His parents were very happy to have the cleft lip treated with negligible scar formation. After few months cleft palate repair will be done.
4 months old baby boy born with unilateral cleft lip and palate
Immediately after suturing using modified Millard's technique
Immediately after suture removal following seven days after surgery showing negligible scar formation
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