Balaji Dental and Craniofacial Hospital - Dr. S.M Balaji, Maxillofacial Surgeron, India - Best Dental Clinic in Chennai : Best Dental Implant Center in India

Successful cosmetic cleft rhinoplasty and secondary cleft lip repair

31/12/2014

A 20 year old boy came to our hospital seeking cosmetic correction of his cleft nose and lip defect which was previously operated elsewhere. He was very particular to have both nose and lip correction done at the same time to improve his appearance.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected his buckled ala of cleft nose defect by removing the deviated nasal septal cartilage intranasally and secondary cleft lip repair done to align the vermillion of upper lip perfectly. Results are immediate and nose symmetry achieved. Patient was very happy to have both lip and nose correction at the same surgery without any surgical marks.

Buckled ala of nose on the right side and incorrect primary cleft lip repair

Immediate postoperative view showing symmetrical nose and corrected lip defect giving pristine appearance

Corrective jaw surgery (orthognathic surgery) for gummy smile

27/12/2014

A 22-year-old boy came to our hospital for expert correction of his protruding upper jaw. The boy was about to begin his career and he was very self-conscious about his appearance.

Clinical and radiological investigation showed his upper jaw or Maxilla was disproportionately larger as compared to the lower jaw and his upper teeth were severely protruding. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the corrective jaw surgery or orthognathic surgery with Le Fort I osteotomy. The upper jaw was set back, reshaped & realigned to his perfect facial harmony. The entire procedure was done from inside the mouth so there were no scars. Immediately following surgery the boy’s appearance was greatly enhanced and his more attractive profile boosted his confidence.

Preoperative facial view showing inability to close upper lip due to lengthened upper jaw - short lip

Postoperative view showing enhanced appearance by reducing the length of the upper jaw without any scars

Fixation of fractured and displaced facial bone intraorally to avoid scar formation

23/12/2014

A 20 year old boy came to our hospital with the complaint of fractured facial bone on the right side due to vehicular accident. He was complaining of facial asymmetry due to medial displacement of fractured cheek bone.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S.M.Balaji diagnosed fractured right body of zygoma with medial displacement. This led to facial asymmetry. To avoid scar formation, intraorally through sulcular incision fractured zygoma was exposed, elevated and fixed using 4 hole titanium bone plate. This improved his appearance dramatically. Patient was very happy to have fractured facial bone fixation without any surgical marks.

Preoperative 3DCT scan showing right body of zygoma fracture and its medial displacement

Fractured zygomatic bone exposed intraorally through sulcular incision

4 hole titanium bone plate was used to fix the fractured segments

Successful removal and reconstruction of huge cystic lesion of lower jaw enhancing the functional stability

23/12/2014

A 20 year old boy reported to our hospital with the complaints of swelling in right side lower half of the face. He also said that this swelling was there for a very long period with occasional numbness in the right side.

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 harvested 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 lesion and reconstruction of the affected portion of mandible in the same surgery.

Preoperative digital orthopantomogram showing large osteolytic lesion involving entire right half of the mandible

Preoperative 3DCT scan view showing erosion of the cortical bone with expansion of the body and ramus of mandible

Harvested costochondral graft used to reconstruct the mandible

Affected portion of the mandible with sufficient marginal clearance was cut and removed intraorally

Affected portion of jaw showing complete osteolysis with wide spread was removed in toto

Harvested costochondral graft used to reconstruct the huge defect

Primary lip repair for unilateral cleft lip and palate baby

22/12/2014

A 2-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. 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 without any scar. After few months cleft palate repair will be done.

Unilateral cleft lip and palate defect in 2 months old baby boy

Following modified Millard's technique primary cleft lip closure done

Immediately after suture removal following seven days of surgery giving enhanced appearance

Successful fixation of fractured facial bone without any scars

20/12/2014

An 18 year old boy came to our hospital with the complaint of fractured facial bone on the right side due to road traffic accident. He had difficulty in opening his mouth wide and was complaining of facial asymmetry due to backward displacement of fractured facial bone.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S.M.Balaji diagnosed fractured right body of zygoma with posterior displacement. This led to difficulty in mouth opening due to hindered movement of coronoid process. To avoid scar formation, intraorally through sulcular incision fractured zygoma was exposed, elevated and fixed using 4 hole titanium bone plate. This improved his mouth opening dramatically. Patient was very happy to have fractured facial bone fixation without any surgical marks.

Preoperative 3DCT scan showing right body of zygoma fracture involving orbital floor and alveolar process of maxilla

Fractured zygomatic bone exposed intraorally through sulcular incision

4 hole titanium bone plate was used to fix the fractured segments

Reduction rhinoplasty with negligible scar formation

18/12/2014

A 55 year old woman reported to our hospital seeking for cosmetic nose correction. She was very particular to reduce the size of the nostrils which gave her an asymmetric appearance on her facial profile view.

Maxillofacial Surgeon Dr. S. M. Balaji successfully planned to correct the nose shape by following closed reduction rhinoplasty technique. Excessive caudal portion of nasal septal cartilage was removed intranasally to avoid scar formation. Results are immediate. Patient was happy to have corrected nose profile and nose tip without any visible scarring.

Preoperative facial view of the nose showing lengthened nasal tip giving asymmetric appearance

Preoperative profile view of nose showing broad widened nostrils showoff

Lengthened nasal tip corrected by removing the excessive caudal portion of septal cartilage

Postoperative view showing reduced length of the nasal tip giving pristine appearance

Postoperative profile view of the nose showing corrected increased nostrils visibility without any scar

Successful primary lip repair for unilateral cleft lip and palate baby

16/12/2014

A 3-month-old baby girl born with unilateral cleft lip and palate was brought to our hospital from Dubai by her 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. Her 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 girl

Primary cleft lip closure using modified Millard's technique

Immediately after suture removal following seven days of surgery showing enhanced appearance

Cosmetic augmentation rhinoplasty without any scars

15/12/2014

A 24 year old girl reported to our hospital seeking cosmetic correction of her nose. She felt the dorsal surface of her nose was flat which gave her an aged look. She wanted to correct her nose profile cosmetically without any scar.

Maxillofacial Surgeon Dr. S. M. Balaji successfully planned to correct her flattened nose by following closed augmentation rhinoplasty. Costochondral rib graft was harvested which was used to augment the dorsum of nose. To prevent scarring, the graft was inserted through intranasal approach. Results are immediate, patient is very happy to have a pristine nose without any surgical marks, which suits her facial profile.

Depressed dorsum of the nose with ill defined nasal bridge

Harvested costochondral rib graft used to augment the dorsum of the nose

Immediate postoperative view showing augmented nasal bridge giving pristine look without any surgical marks

Defective nose profile corrected by Closed Augmentation Rhinoplasty

12/12/2014

A 35 year old lady from Tiruppur came to our hospital with a complaint of deficient bridge portion of nose. The midlevel of the dorsum of the nasal bone, where there was a deficiency created a huge negative impact on the facial profile. This gave her an aged appearance too. Maxillofacial Surgeon Dr. S.M. Balaji planned a closed rhinoplasty technique wherein the surgical approach is through the nose to prevent unsightly scars.

Appropriate measurement of nose was made and the amount of augmentation needed was noted. Autologous costochondral graft (rib graft) was harvested, shaped and positioned to improve the aesthetics of the nose. Width of the alar base was corrected by Weir excision. The patient was very happy with the surgery outcome and to have an enhanced appearance.

Postoperative profile view showing augmented nose without any visible surgical marks

Immediate postoperative view showing reduced width of the nose with alar base width reduced using Weir excision

Preoperative view showing broad flattened nose with wide alar base

Preoperative profile view of nose showing deformed nasal bridge with everted nasal tip

Primary lip repair for baby with unilateral cleft lip and palate

11/12/2014

A 2-month-old baby boy born with unilateral cleft lip and palate was brought to our hospital from Dubai 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 remarkably improved and he 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.

Immediate postoperative view following suture removal after seven days of surgery

Primary cleft lip repair following modified Millard's technique

Unilateral cleft lip and palate defect in 2 months old baby boy

Boy with cleft lip and palate suffering from Hemophilia operated

9/12/2014

An 8 year old boy a case of unilateral cleft lip and palate reported to our hospital with the complaints of regurgitation of food to the nose due to cleft defect. Primary cleft lip and palate repair was done elsewhere. This boy is a severe Hemophiliac A factor VIII deficiency patient (< 1%). Hemophilia is a type of genetic disorder where clot forming protein (Factor VIII, IX, XI) levels will be less which leads to continuous bleeding in case of injury, surgery, or unknown internal bleeding in the joints (knee etc.,). Palatal flap done elsewhere had failed due to failed postoperative clot formation which led to secondary cleft palate defect. This affects the feeding and speech dramatically.

After thorough clinical, radiological and hematological analysis, Maxillofacial Surgeon Dr. S. M. Balaji planned to close the cleft alveolus defect and secondary cleft palate correction (Re palate) as a single surgery with extraordinary pre and postoperative care. Patient needed 100% f VIII levels for the intimated 72 hours to have good healing results.

Preoperative CBCT scan showing unilateral cleft alveolus on the right side

Cleft palate defect due to improper primary cleft palate closure

Miracle protein rhBMP-2 used to close the alveolar cleft defect

Immediately after closure of the alveolar cleft defect and palatal defect

Palatal cleft completely closed using palatal push back technique

Antihemophilic factor (Human) VIII C pasteurized monoclonal antibody purified was used to enhance the clot formation

Alveolar cleft repair using rhBMP-2 avoiding bone graft

6/12/2014

An 8-year-old boy was brought to our hospital by his parents for surgical correction of his cleft defect. His cleft lip and cleft palate defect was operated by Maxillofacial Surgeon Dr. S.M. Balaji, in his childhood.

Dr. 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.

Preoperative CBCT scan image showing unilateral alveolar cleft in left side of the maxilla

Preoperative intraoral view showing cleft alveolus in the left side of the upper jaw

Gingivomucoperiosteal flap raised and alveolar cleft defect was exposed

Miracle protein rhBMP-2 was placed in the alveolar cleft defect to induce the new bone formation

Successful dynamic sphincter pharyngoplasty for correction of nasal sounding speech in cleft patient

4/12/2014

A girl with isolated cleft palate, who had undergone cleft palate surgery elsewhere in her childhood, reported to our hospital seeking to correct her speech defect. Her speech had a nasal twang and the pronunciations of certain words were not clear.

Cleft afflicted individuals may have hypernasality or a nasal sounding speech. This condition is called velopharyngeal incompetence or VPI and occurs due to escape of air through the nose while speaking. Maxillofacial Surgeon Dr. S.M. Balaji performed a dynamic sphincter pharyngoplasty for VPI correction. Palatopharyngeus myomucosal flaps were raised from both sides, criss-crossed and rearranged leaving a small opening or “port” for breathing through the nose.

Positive suction test following sphincter pharyngoplasty shows new dynamic velopharyngeal sphincter action indicating successful correction of velopharyngeal incompetence.

Velopharyngeal incompetence causing nasal sounding speech

Palatopharyngeus myomucosal flaps were raised from both sides

Flaps criss-crossed and rearranged to create dynamic sphincter

After successful sphincter pharyngoplasty surgery creating a small port Positive suction test indicating successful correction of VPI