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Cosmetic rhinoplasty for broad nose with depressed nostril on left side without any scars

29/4/2015

A 32 year old lady from Andhra Pradesh reported to our hospital seeking for cosmetic correction of her nose shape. Her nose was deviated towards right side and flat dorsum of the nose made her feel conscious about her facial appearance. She had consulted many surgeons before for the correction of her nose without any visible surgical marks on her face. She was not convinced.

Maxillofacial surgeon Dr S. M. Balaji successfully corrected her nose shape without any visible surgical marks on her face. By following closed rhinoplasty technique the severely curved caudal portion of nasal septal cartilage was removed and by lateral osteotomy technique the broad nasal bridge was narrowed. Thus her nose was made pristine and she feels very happy to have her complete nose correction without any scars on her face.

Facial view showing deviated nose towards right side with flat dorsum

Asymmetrical nostril shape due to septal deviation

Caudal portion of nasal septal cartilage was exposed

Excessively curved nasal septal cartilage was removed

Immediate postoperative view following lateral osteotomy showing prominent nasal bridge

Corrected shape of the nostrils without any visible surgical marks on the face

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

27/4/2015

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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 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

Immediately after suturing the cleft lip defect

Immediately after suture removal following seven days of surgery

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Surgical facial enhancement for forehead depression and deep nasal bridge

23/4/2015

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A 32 year old man from Bangladesh reported to our hospital for his forehead depression correction. Due to a road traffic accident few months back he had frontal bone fracture and posterior displacement of the bone. He wanted to correct the forehead defect.

After thorough clinical and radiological assessment, Maxillofacial Surgeon Dr S M Balaji diagnosed that due to fracture of the outer table of the forehead (frontal) bone he had a depression and there was a deep nick in the nasal bridge also which required surgical correction. Surgery was done through the previous scar in the forehead and costochondral rib graft was used to augment the defect. Bridge of the nose was also enhanced using rib graft through the same incision. Patient feels very happy to have both forehead and nose correction done in the same surgery improving his appearance without much surgical marks on the face.

Preoperative 3DCT scan view showing forehead depression due to RTA

Facial view showing forehead depression between the brows and depressed nasal bridge

Harvested costochondral rib graft used to augment the forehead defect and nasal bridge

Nasal bridge also raised using rib graft

Through the previous scar the harvested rib graft was placed

Immediately after suture removal

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Alveolar cleft repair using rhBMP-2 avoiding bone graft

22/4/2015

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An 8-year-old girl was brought to our hospital by her parents for surgical correction of her cleft defect. Her cleft lip and cleft palate defect was operated elsewhere, in her childhood.

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.

Alveolar cleft defect

3D CBCT scan showing alveolar cleft defect in right side upper jaw

Alveolar cleft region surgically exposed

rhBMP-2 placed in alveolar cleft avoiding bone graft

Immediately after surgery-surgical site sutured

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Augmentation rhinoplasty for cleft nose correction

20/4/2015

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A 22-year-old girl from Bihar was brought to our hospital by her parents for expert correction of her cleft nose & lip defect to enhance her appearance. Her nose was flattened and collapsed on the left side and there was an unsightly scar on the lip which affected her appearance. She was previously operated elsewhere for her unilateral cleft lip and palate in her childhood.

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the cleft rhinoplasty & cleft lip revision. A costochondral rib graft was harvested and used to augment the dorsum of the nose. The surgery was done from inside the nose so there were no scars. Lip revision was also done in the same procedure. Immediately following surgery, the girl’s appearance improved greatly and she was very happy with the surgery outcome.

Facial view showing asymmetrical nose due to cleft defect

Profile view showing depressed dorsum of the nose

Due to cleft defect there was depressed left alar base with altered nostril shape

Harvested costochondral graft used to augment the dorsum of nose and straighten the nasal bridge and secondary lip repair done

Immediately after suturing the lip defect and corrected dorsum of the nose without any surgical marks

Augmented dorsum of the nose giving pristine appearance without any visible surgical marks on the face

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Complete jaw reconstruction of missing left side Mandibular ramus, condyle and temporomandibular joint to correct face asymmetry

10/4/2015

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A 13-year-old girl was brought to our hospital by her parents for specialized jaw reconstruction surgery. The girl’s lower jaw was deviated to the left side causing asymmetry of the face. Since birth the back portion of the left side lower jaw (Mandibular ramus and condyle) was missing causing difficulty in speaking and chewing. Also the lower jaw deviated to the left side while opening the mouth. The girl’s appearance was also affected making her self-conscious.

The 3D CT scan revealed complete absence of the posterior portion of the lower jaw left side. The left side jaw joint or temporomandibular joint was also absent. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the jaw reconstruction surgery. A costochondral rib graft was harvested and used to reconstruct the missing left mandibular ramus, condyle and temporomandibular joint. Immediately following jaw reconstruction, the face appeared symmetrical improving her appearance. The girl will require post-surgery physiotherapy to rehabilitate the jaw joint function.

Preoperative facial view showing complete shifting of mandible towards left side leading to facial asymmetry

Preoperative digital orthopantomogram showing absence of mandibular ramus and condyle on left side

3DCT scan view showing complete congenital absence of ramus and condyle on left side

Preoperative mouth opening with jaw deviation towards left side

Costochondral rib graft harvested to reconstruct the structural and functional component of condyle

Harvested costochondral rib graft stabilized with the rest of the mandible

Immediate postoperative digital orthopantomogram showing reconstructed left condyle and ramus using rib graft

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Successful premaxillary setback and complete closure of huge alveolar cleft using miracle protein rhBMP-2 in a bilateral cleft lip and palate boy

8/4/2015

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An 8-year-old boy born with bilateral cleft lip and palate reported to our hospital seeking specialized treatment for her cleft defect in the alveolar bone (teeth bearing region of upper jaw). He was previously operated for cleft lip & cleft palate elsewhere.

Due to the bilateral cleft, his maxilla or upper jaw bone was in 3 parts. Anterior segment (premaxilla) was so much forwardly placed. Maxillofacial Surgeon Dr. S.M. Balaji performed the alveolar cleft reconstruction using the miracle protein rhBMP-2 following premaxillary setback. This protein stimulates the body’s own cells to rapidly form new bone at the site of placement. Following surgery, there will be complete bone fill in the cleft defects thereby joining the 3 segments into a single complete maxilla.

By using this revolutionary technology, additional bone graft surgery and scarring at the graft site is avoided. Dr. Balaji has successfully used this novel protein in complete reconstruction of several facial bone defects.

3D CBCT scan view showing detached premaxilla due to cleft defect

During surgery complete separation of premaxilla with that of the maxilla was exposed

Following premaxillary setback alveolar cleft defect was closed with rhBMP2 bone protein

Alveolar cleft defect was corrected by placing miracle bone protein rhBMP2

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Cosmetic rhinoplasty for broad nose with depressed nostril on left side without any scars

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

Surgical facial enhancement for forehead depression and deep nasal bridge

Alveolar cleft repair using rhBMP-2 avoiding bone graft

Augmentation rhinoplasty for cleft nose correction

Complete jaw reconstruction of missing left side Mandibular ramus, condyle and temporomandibular joint to correct face asymmetry

Successful premaxillary setback and complete closure of huge alveolar cleft using miracle protein rhBMP-2 in a bilateral cleft lip and palate boy

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