- Not feeling proper bonding of the bone graft internally at the operated site. Sound of friction type when moving lower jaw
- Shift of lower jaw to the left during mouth-opening
- Left side of lower lip is numb
- Have been chewing food only on right side for last 8-9 years, cannot chew on the left side (sometimes feels pain in right side lower jaw)
- Concerned about the functionality of the upper left teeth & gums
Multiple mandible surgeries done elsewhere failed, Complete reconstruction done successfully by Dr. S. M. Balaji
A 30 year old man from Bangladesh reported to us seeking reconstruction of left side of his lower jaw. Intraorally, a bone graft was exposed and huge infection with pus discharge adjacent to the exposed region was noticed. He gave a history of dentigerous cyst in the left side of the lower jaw, the affected portion of the lower jaw along with the involved teeth were removed elsewhere and the jaw was reconstructed with fibular and iliac bone graft with bone plate thrice, 2 years back. He was frustrated due to repeated surgeries, that too which had subsequently failed.
Difficulties faced – in patient’s words
Maxillofacial Surgeon Dr. S. M. Balaji planned to remove the failed infected bone graft done elsewhere and to reconstruct the lower jaw in a single surgery. He approached the surgical site intraorally and removed the dislodged bone graft and sequestrum completely. Adjacent infected bone was removed with bone curette. A rib graft was taken and fixed to the lower jaw left side to reconstruct the defect. rhBMP-2 was placed to increase the efficiency of new bone formation. Mucosal flaps were approximated in layers. The patient is very happy to have entire surgery done in single stage without any scar on the face. The functionality of the lower jaw was also regained efficiently.
5 year old boy with failed TMJ ankylosis Surgery done elsewhere was corrected successfully by Dr. S. M. Balaji using growth centre transplantation
A 5 year old boy was brought to our hospital with a complaint of decreased mouth opening and facial deformity by birth. His parent’s gave the history of multiple surgical correction of TMJ ankylosis done elsewhere. He had unsightly extraoral scar due to previous surgeries. He gave a history of having undergone distraction osteogenesis treatment for the left side of the lower jaw in some other hospital elsewhere, but the treatment subsequently failed.
Now on examination he had facial asymmetry, severely retruded lower jaw (mandible), flattened lower face with complete restriction in mouth opening and shift of chin towards left side.
3DCT of facial bones revealed obliterated left temporomandibular (joint jaw) joint space, elongated coronoid process, and reduced ramal height and prominent antegonial notch. The case was diagnosed as true left TMJ bony ankylosis with developing secondary facial deformity.
Maxillofacial Surgeon Dr. S. M. Balaji successfully performed bony ankylosis release surgery and transportation of growth centre using costochondral junction obtained from rib cartilage. Postoperative mouth opening was adequate. Following complete dental rehabilitation done to treat the badly broken and decayed teeth, boy’s parents were asked to continue the mouth opening exercise at least 2 months after surgery.