A 10-year-old boy was brought to our hospital by his parents for reconstruction of his alveolar cleft. He was previously operated for cleft lip and cleft palate in his childhood. On his parents’ request he was planned to undergo bone graft surgery.

Maxillofacial Surgeon Dr. S.M. Balaji grafted bone from the boy’s hip region and the harvested bone was jam packed in the cleft to completely close the defect. Closure of alveolar cleft defect either by bone graft or BMP will ensure proper eruption of permanent teeth. Further cleft management will be done subsequently. 

A two-month-old baby boy born with unilateral cleft lip and palate was brought to our hospital by his parents for comprehensive management of the cleft deformity.

Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction using Modified Millard’s technique. Following surgery the baby’s appearance improved remarkable and he was able have milk without much difficulty. The baby’s parents are very happy with the surgery outcome. Cleft palate repair will be done subsequently. 

A 22 year-old girl reported to our hospital seeking to correct the shape of her nose. Her nose was broad, flattened and appeared humped in the profile view. She wanted a more attractive nose that would enhance her appearance.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the augmentation rhinoplasty. A costochondral cartilage graft was harvested and used to reconstruct the deformed dorsum of the nose. The graft was placed from inside the nose so there was no scarring. The nose was made sharp, defined and pristine which greatly enhanced her facial appearance. The girl was very happy with the surgery results. 

A 3 months old boy baby with incomplete cleft lip was brought to our hospital by his parents for correction of his cleft lip defect.

Maxillofacial Surgeon Dr. S. M. Balaji skillfully performed the primary cleft lip repair by following Modified Millard’s technique. Results are immediate and the parents were very happy to see their boy with complete correction of cleft lip without much surgical marks. 

A 59-year-old lady reported to our hospital with a complaint of swelling with severe pain in her lower jaw on the right side. A digital X-ray took revealed a large cystic lesion in the right mandibular ramus region involving the molar teeth.

Histopathological examination of the specimen showed it to be an odontogenic keratocyst. Maxillofacial surgeon Dr. S.M. Balaji expertly performed a marginal excision resecting the affected part of the jaw completely. Following surgery the wound healed well and the patient was happy to be cured of her ailment.

A 27-year-old man from Kolkata reported to our hospital seeking expert craniofacial reconstruction. He had met with a vehicular accident few months back and suffered fracture of the forehead, cheek bones & lower jaw. He underwent initial surgery elsewhere. He had a gross skull defect with a depression in his left forehead. He also complained of continuous tears running down his face from his left eye.

3D CT scan revealed fracture of the frontal bone on the left side. Due to the traumatic injury, a defect in the nasolacrimal duct caused epiphora or abnormal tear flow. The normal flow of tears from the eye to the nose was damaged.

Craniofacial surgeon Dr. S.M. Balaji skillfully performed the complex reconstruction. A cortical bone graft was harvested from the rib and used to reconstruct the left forehead. Miracle protein rhBMP-2 was placed on the bone graft to stimulate new bone formation.

The defect in the nasolacrimal duct was corrected with DCR or Dacryocystorhinostomy. The ostium was opened with rongeurs, bone adjacent to nasolacrimal sac was removed. A new direct communication was created between the nasolacrimal sac & the nasal mucosa by placing a silicone tube to enable the tears to drain into the nose. Complete craniofacial defect was corrected successfully.

A 1-year-old baby girl born with isolated cleft palate was brought to our hospital by her parents for expert treatment of the cleft defect. The baby’s cleft palate defect was classified as Millard’s 10 and 11.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the cleft palate correction with palatal pushback technique. A palatal flap was raised on both right and left side. The Levator palatine muscle was detached from their abnormal positions and reattached to its normal position like a hammock. A two layer closure – closure of nasal floor and oral floor - was done. Cleft palate repair was successful and results were immediately seen with a positive suction test where the soft palate muscles move upwards due to the vacuum created in the nasal passage with the suction that ensures improved speech

A 15 year old boy with unilateral cleft lip and palate reported to our hospital with the complaints of asymmetrical nose and depressed nostril on the right side due to huge cleft defect. And he wants to correct his jaw alignment where the lower jaw is prognathic due to which he was not able to bite and chew any hard food stuffs. Defective nose profile reduced his self confidence considerably.

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his cleft nose defect as well as the jaw alignment simultaneously. Cleft nose defect was corrected with columellar strut graft harvested from the ribs, through intraoral approach and shape of the ala was maintained. Also alar base was raised with the graft.

Skeletal malocclusion correction was done by subapical osteotomy and thus skeletal cross bite was corrected. Patient and his parents were happy to have both the defective nose and bite correction done simultaneously without any scars on the face. Results are immediate. 

A 20 year old girl reported to our hospital with a complaint of asymmetrical face giving her an unpleasant appearance and she was not able to chew foods due to slanting bite. Her parents were also worried & wanted the correction done without any scars on the face. The girl was too anxious due to her asymmetrical face which affected her self-esteem considerably.

After thorough clinical and radiological examination, it was diagnosed that she had hemifacial microsomia in which the ramul height of the mandible on right side was considerably less which led to asymmetry. Maxillofacial Surgeon    Dr. S. M. Balaji skillfully planned to correct her face as well as her bite with the innovative “Distraction Osteogenesis” technique. Intraorally Le Fort I osteotomy was done, lower jaw bone on the right side was cut and distractor device was fixed to the mandible at the ramus region. The screw attached to the distractor was turned gradually everyday that pushed the cut bone segments apart. New bone was formed in the resultant gap and the jaw bone was ultimately lengthened. After the face became symmetrical, the distractor was removed.

Thus entire surgery was done inside the mouth with no scars on the face.  The girl and her parents were very happy with the results.

A 20-year-old man reported to our hospital seeking to correct the appearance of his nose. His nose was much flattened in the middle and he wanted to have a sharp nose to improve his appearance.

Maxillofacial surgeon Dr. S.M. Balaji expertly performed the augmentation rhinoplasty. A costochondral cartilage graft was harvested and used to reconstruct the depressed, collapsed dorsum of the nose. The surgery was done from inside the nose (closed rhinoplasty) so there was no scarring. The patient was very happy to have a sharp, defined & pristine nose immediately after surgery, which improved his appearance.  

A 30 year old man from Oman came to our hospital with the complaints of severe pain and swelling in the right side of his lower jaw. A 3D CT scan & thorough histopathological examination revealed he had multilocular ameloblastoma in the right lower jaw.

Maxillofacial surgeon Dr. S.M. Balaji expertly planned the complete jaw reconstruction. The affected portion of the mandible (lower jaw) was surgically ressected. A rib graft was harvested & used to reconstruct the excised portion. Miracle protein rhBMP-2 was placed. This stimulates the body’s own cells to form new bone at the site thereby ensuring complete healing of the bone defect.

Few months following surgery, remarkable healing of the jaw bone defect was seen. Implants were placed in the missing teeth region of the lower jaw and ceramic prosthesis were fixed. The man was very happy that his jaw bone defect is cured completely and with the implants he is able to chew & eat well. 

A 2-month old baby girl from Maldives born with unilateral cleft lip and palate was brought to our hospital by her parents for cleft treatment.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the primary cleft lip repair using modified Millard’s technique. Following surgery, the baby’s appearance & feeding improved greatly. The baby’s parents were very happy that the surgery caused no scars on the face. They have gone back to their homeland and will return subsequently for cleft palate surgery.

A 12-year-old boy born with isolated cleft palate was brought to our hospital by his parents for surgical speech correction. He was previously operated elsewhere multiple times for his cleft palate defect. He had a nasal twang in his speech. This condition is called velopharyngeal incompetence that occurs in cleft children due to escape of air through the nose while speaking.

Maxillofacial Surgeon Dr. S.M. Balaji expertly performed a dynamic sphincter pharyngoplasty surgery wherein the palato-pharyngeal muscles were criss-crossed to correct the velopharyngeal incompetence. The video shows the new dynamic velopharyngeal sphincter action and a positive suction test indicating successful correction of velopharyngeal incompetence.  

An 18-year-old boy reported to our hospital seeking to correct his cleft nose defect that affected his appearance. He was operated elsewhere in his childhood for bilateral cleft lip and palate. Due to the cleft defect his nose was deformed and beak shaped. 

Maxillofacial surgeon Dr. S.M. Balaji skillfully performed the cleft rhinoplasty. A costochondral cartilage graft was harvested and the dorsum of the nose was augmented using the graft. The prominent lower lateral nasal cartilage was removed on both sides to correct the ala defect and reconstruct the structure of the nostrils. The surgery was done from inside the nose so there was no scar. Immediately after surgery, the nose appeared sharp and defined and the boy was very happy with the scarless results. 

A 30-year-old woman reported to our hospital seeking expert treatment to correct her nose deformity to improve her appearance. She was previously operated elsewhere for unilateral cleft lip & palate. Also nose correction was done elsewhere but the results were esthetically disappointing and excessive contraction of the scar led to severe constriction of the left external nostrils. Her flattened nose was collapsed on the left side making her face look unattractive.

Maxillofacial surgeon Dr. S.M. Balaji skillfully performed the rhinoplasty. A nasolabial flap was raised and used to reconstruct the severely constricted external nostrils by shaping the left ala of the nose. A costochondral rib graft was harvested and used to reconstruct the dorsum giving the nose a sharp, defined form. Following surgery, the patient was very happy with her enhanced appearance without any scars on the face. 

An 18-year-old boy afflicted with Parry-Romberg syndrome reported to our hospital seeking to correct his facial asymmetry. His left side face was defective leading to slanting bite and an obvious asymmetry of the face. The radiographic examination showed a grossly under-developed upper and lower jaw on the left side. 

Eminent Craniofacial Surgeon Dr. S. M. Balaji adopted a stage-by-stage rehabilitation. To correct the jaw deformity, he applied the innovative simultaneous maxillary and mandibular distraction procedure. Le Fort I osteotomy was done for the upper jaw. The lower jaw bone was cut and the distractor device has been placed. A screw attached to the distractor is turned gradually at a rate of 1 mm per day. The bone segments move apart and new bone is formed in the gap to lengthen the jaw.  After the required length is achieved and new bone is stabilized, subsequently correcting the asymmetry of the face, the distractor device will be removed. 

This will be followed by correction of soft tissue defect by fat grafting as the second stage. We will be updating this case with more details as the treatment proceeds. 

A 12 year old boy with bilateral cleft lip and palate reported to our hospital with the complaints of defective upper lip and ill-defined nose tip with depressed nasal bridge. His parents were not happy with the boy’s appearance and he was not able to spell few words due to defective upper lip which made him more depressed. 

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planed to correct his upper lip defect as well as his ill- defined tip of the nose by following Abbe flap technique. Surgery was done in two stages. In the first step, prolabium was raised to increase the columellar length and nasal tip projection. And the cleft lip defect was corrected with Abbe flap technique were lower lip tissue was raised and attached to the upper lip defect region. In the second step, achieving good healing after 25 days the upper and lower lip was surgically separated and thus nose as well as lip defect correction was done simultaneously without many surgical scars. The boy and his family was very happy to see the enhanced appearance of the nose and well aligned upper and lower lips without any surgical scars.

A 3-year-old Maldivian boy was brought to our hospital by his parents for expert surgical treatment of his cleft deformity. The boy was born with bilateral cleft lip and palate. He previously underwent cleft lip & palate repair at a hospital in Trivandrum. The treatment done there was grossly incorrect resulting in a terrible defect. The upper lip got fused with the gums of upper front teeth. The labial vestibule or gap between the upper lip and gums of teeth was completely obliterated.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the upper lip and alveolus reconstruction. Preserving the blood supply, the lip and alveolus was successfully separated and reconstructed to create the labial vestibule. Pre-maxillary setback was done using Paul Black technique. Following surgery and suture removal there was good healing. The boy’s appearance, speech and eating improved significantly. The boy and his family were very happy with the defect correction and went back to their hometown and they are to return for further cleft management.

An 18 year old boy was brought to our hospital by his parents for complete reconstruction of his ear defect. He had a large button-holing defect in the helix of his left ear due to which he was teased a lot and it affected his self-confidence.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the surgical ear reconstruction in 2 stages. In the first stage the specialized island flap was raised just behind the ear and the edges of the button holing defect in the pinna of the ear was cut. The defective pinna of the ear was sutured with the island flap behind the ear. In the second stage after 6 months, the pinna of the ear was separated from the flap behind the ear and the detached region was sutured. The size of the defect was measured using lint and the required size of skin graft was harvested to close the raw plane of the ventral surface of the ear and it was sutured by means of quilting technique to avoid spacing between the skin graft and recipient site and seroma formation. Thus total reconstruction was done without much surgical scars. Results are immediate and we will update this case by post operative photos with complete healing later.