A 15 year old girl with unilateral cleft lip and palate reported to our hospital wanting to correct her nose. Previous cleft surgeries like primary cleft lip, cleft palate was done elsewhere. Alveolar cleft defect was repaired with rhBMP-2 in our hospital. 

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct her nose using closed rhinoplasty technique. Due to severe cleft defect, nasal septum was deviated towards right side and columellar base was buckled and depressed on left side of face. Intra nasally, the deviated nasal septum was dissected and made straight. Depressed lower left ala was lifted up by placing the shaped costal graft and the cartilaginous strut graft was positioned between the medial crura that make up the columellar base and thus the nose was reshaped to normal size. Both the nasal septum and columellar base was adjusted in such a way the nose was made more pristine to her face. Results are immediate and both the patient and her parents were very happy to have her defective nose corrected without any scars.

A girl with unilateral cleft lip and palate was brought to our hospital by her parents with the complaints of mal aligned teeth and escape of water through the nose due to the cleft defect. Primary cleft lip and palate repair was done elsewhere. 

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct her alveolar cleft defect using iliac bone grafting technique according to her parents’ request. With very minimal incision line in the hip region, the iliac crestal bone was successfully harvested. The incision made was approximated in such a way resulting in very minimal scarring. The harvested graft was placed in the alveolar cleft defect region and approximated to the extent of defect. 

Patient was comfortable to have a very minimal incision mark left after surgery in her hip region resulting in good healing with very minimal scarring.  Her parents were also happy to have her daughter to feel comfortable after surgery. They returned to their home place and were asked to come for further follow-ups and cleft management.

A 40 year old man reported to our hospital with the complaints of huge swelling in the left side of face. He gave the history of previous surgery done elsewhere, were they have removed a tumor extra orally but it got recurred. He also explained about the nature of swelling as he had noticed the swelling 2 years back. But the swelling was small at that time, later it started to grow slowly and extended to the present size now. Initially he had tenderness in the cheek region, but later there was no pain.

After thorough clinical and radiological examinations, it was diagnosed as recurrent Neurofibroma. Maxillofacial surgeon Dr. S. M. Balaji skillfully planned to remove the tumour completely as well as to reconstruct his face. Through the previously operated nasolabial scar, the tumor was exposed by raising the infra orbital skin. Tumor was separated from the maxilla and zygomatic bone and removed completely. Tumor was adherent to the previously operated site which was also detached and removed completely.

The ectropion (turning out of the lower eyelid) in the left eye was repaired with lateral canthotomy incision and orbital septal return flap technique. The inferior tarsal plate was sutured with supra orbital periosteum. Excess skin in the nasolabial area was excised and wound closed in layers.

A 25 year old man reported to our hospital wanting to correct his deviated abnormally large sized nose. Because of his appearance of the nose, he was very depressed and he wanted to make his nose pristine without any scars.

Maxillofacial surgeon Dr. S. M. Balaji skillfully planned to correct the nose by following reduction rhinoplasty technique and alar base shaped by using weir excision. Bilateral incisions are made inside the nose and connected by transfixation intercision. Deviated nasal septum was exposed and dissected in such a way that the anterior part was excised in a triangular manner. Both lower lateral cartilages (cephalic portion- foot plate of medial crus) were excised and removed leaving the caudal portion intact.

Both side upper nasal cartilages were divided in the midline through a cut made in the superior part of upper cartilage of the septum (medial osteotomy). Dorsum of the nasal bone was osteotomized by lateral osteotomy technique and rough surface of the nasal bone was smoothened with the rasp. Weir excision was made to shape the ala of the nose. And the flaps were approximated in layers. Results are immediate. The surgery was done within the nose resulting scar less appearance and the nose was shaped to normal size and shape which well blended to his facial appearance and also enhanced the profile of the face.

A 28 year old male reported to our hospital with the complaint of deviated nose with depressed nasal bridge and left nostril. His nose was flattened with the ala in the varying level in both sides.

Maxillofacial Surgeon Dr. S.M. Balaji corrected his nose by following Augmentation Rhinoplasty technique with Alar base correction. Cartilage graft has been harvested and sculpted for the correction of depressed nasal bridge. The nasal septum and foot plate of medial crus is removed surgically from the left side along with the correction of alar base. The surgery was done within the nose so there are no scars on the face. Results are immediate and he is happy to have a renewed confidence to have a pristine nose with a new, improved look. 

A 15 year old boy with unilateral cleft lip and palate from Tirupur reported to our hospital wanting to correct his nose and alignment of his teeth. Primary lip and palate repair was done in his hometown itself during his childhood. He and his parents were more upset regarding his scar results after lip repair which affect his moustache growth as well as his broad asymmetrical nose made his face look disproportionate. 

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his cleft defects to overcome the future growth huddles. Considering their level of distress they had in the results of previous surgeries, multiple cleft defects were planned to be corrected in a single surgery. Deviated nasal septum was aligned through intra oral approach using chondral graft obtained from his rib. Thus his nose defect was shaped to normal shape and size.

His cleft alveolar defect was closed with miracle protein rhBMP-2. His lip defect which was due to incorrect approximation of mucosal flaps leaving the vermillion of the lip defective. Thus, vermillion defect was corrected and scar formed due to incorrect technique was removed precisely with very minimal scar formation.

Results are immediate showing enhanced appearance of his face due to pristine nose correction and scar revision.