This gentleman was born with microtia of the right ear. Microtia is the congenital deformity of the external ear. Reconstructive surgery is performed in two stages. He presented to our hospital for surgical correction of his microtia ear deformity. 

A template was first made using the left ear to ensure that the reconstructed right ear was symmetrical to the normal left ear. Costal rib graft with perichondrium was then harvested from the patient. The graft was crafted using the template for reconstruction of the right ear. Markings were made in the region of the deformed right ear and a subcutaneous pocket was created. The crafted cartilaginous graft was placed in the pocket and the incision was closed with sutures.
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The second stage was performed in four months with lifting up of the cartilaginous graft along with placement of a skin graft in the postauricular region. This resulted in reconstruction of a symmetrical right external ear.

This child was born with unilateral macrostomia, which was on the left. There were no other associated structural abnormalities. Her parents presented at our hospital for corrective surgery. Treatment planning was explained to them and they consented to surgery.

The new commissure was marked to ensure postsurgical symmetry with the normal right side. Orbicularis oris was reconstructed using the vermilion return flap. Repair was performed in three layers using the muscles, subcutaneous tissue and skin. This would result in negligible scar formation.

She will now be able to speak clearly and eat without dribbling. Her appearance was also completely normalized with establishment of symmetry. Her parents were very pleased with the results of the surgery.

This baby girl had been born with a unilateral isolated cleft lip deformity. This is the mildest form of cleft deformity, but the most difficult surgery to get best results. Her parents had been counseled at the time of her birth and referred to our hospital.

The nasal sill was addressed using a C-flap. It was then decided to do a three layer closure of her cleft lip deformity. The orbicularis oris, subcutaneous tissues and skin were reapproximated with extreme precision with the use of a surgical loupe. There was perfect recreation of lip anatomy.
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The postoperative picture is at the 7th day after surgery. Her parents were extremely happy with the results of the surgery.

This young girl with hypertelorism was first operated on when she was six years old. Her parents presented with her once she had completed bone growth as instructed at the time of the initial surgery for further corrective surgery. A revision hypertelorism surgery was planned with a box osteotomy and facial bipartition procedure.

Comprehensive studies were obtained preoperatively including axial section CT scans of the facial bones. A mock surgery was then performed on a 3D stereolithographic model of her skull in consultation with the neurosurgical team that was closely involved in each step of the treatment process.

A bicoronal flap was raised and craniotomy was performed after removing previous screws and plates. Extreme care was taken to ensure that there was no damage to the duramater and the traditional frontal bar cut was performed.

Care was taken to preserve the olfactory bulb while handling the crista galli region. The segmental cuts were made with great care and medial nasal part was removed. This was followed by the orbital cut of the box osteotomy, which was performed as planned. Great care was exercised while handling the nasolacrimal duct to ensure that there would be no complications in the future.

The lower cut performed intraorally would result in movement of the midfacial segment alone and not the entire alveolus. After completely mobilizing the midfacial segments and removal of excess tissue, the edges were approximated. The frontal bar served as a standard guide for this procedure. They were secured with plates and screws. The position of external eye and nose were rechecked. Then the incisions were closed in layers.

There was optimal correction of the patient’s hypertelorism following the surgery. She would need a series of further surgeries to complete the rehabilitation process.

This little girl was born with a right-sided hemifacial microsomia with macrostomia. Hemifacial microsomia might be genetic or can be acquired through disruption of in utero vascular supply to the facial region. It is most commonly unilateral.

She had right-sided macrostomia, a short lingual frenum with resultant tongue tie and a prominent right preauricular cartilaginous ear tag.

The short lingual frenum was addressed first. Fibers of the lingual frenum were dissected free and the tongue tie was released. Her right-sided macrostomia was corrected using a vermillion return flap technique. This involved reconstruction of the modiolus on the right side.

The orbicularis oris muscle was first identified and sutured. Buccinator was then identified and sutured. This resulted in a symmetrical reconstruction of the angle of the mouth.

Attention was then turned to the right ear tag. An incision was made and the cartilaginous part of the ear tag was dissected and excised. The incision was then closed resulting in establishment of good facial esthetics for the little girl from the surgery.
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Her parents were extremely satisfied with the results of the surgery.

This young man had suffered a bullet injury to the right infraorbital region, had suffered from extensive injuries including a blow out fracture of the right orbit and had undergone extensive reconstruction in the first stage of surgical correction of his deformities.

He now presents for second stage surgery for correction of resorption of infraorbital fat, ectropion deformity and excessive scleral show of his right eye. Treatment planning was explained to him and he consented to surgery.

A subdermal fat graft was harvested and tunneled into the infraorbital region for reestablishment of symmetry. He then underwent superior repositioning of his lateral canthal ligament with correction of his ectropion and excessive scleral show.

He was very happy with the results of the surgery.

This little girl had a congenital bilateral cleft lip and palate deformity. Her parents were counseled regarding her cleft deformities at the time of her birth.

She was brought to our hospital for surgical correction when she was 8 months old. Her bilateral cleft lip deformity was addressed first. She had a very wide cleft with a mobile premaxilla. Her prolabium was also very tiny along with a very short columella. There was also very minimal tissue for reconstructing the lip.
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She underwent a single stage repair utilizing Paul Black’s technique. No cross incision was made at the prolabium. Available prolabium and columella were utilized for reconstructing the philtral column and Cupid’s bow.

This was followed by creation of the nasal floor and vermillion. Bilateral C-flaps were utilized for this. Extreme care was taken as there was very minimal tissue available. This was followed by meticulous three layer closure of the cleft lip under loupe magnification. Orbicularis oris muscle was approximated at the midline. This was followed by approximation of the subcutaneous tissue and skin.
Her parents were extremely happy with the results of the surgery.

This little boy had incomplete bilateral cleft lip and palate deformity. This was very mild. His parents were extensively counseled regarding the management of his deformity and sent to our hospital for corrective surgery.

His bilateral cleft lip deformity was addressed first. At the age of 3 months, he underwent a single stage repair utilizing Paul Black’s technique. No cross incision was made at the prolabium. Available prolabium and columella were utilized for reconstructing the philtral column and Cupid’s bow.

This was followed by creation of the nasal floor and vermillion. Bilateral C-flaps were utilized for this. This was followed by meticulous three layer closure of the cleft lip under loupe magnification. Orbicularis oris muscle was approximated at the midline. This was followed by approximation of the subcutaneous tissue and skin.
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Her parents were extremely happy with the results of the surgery.

This man had lost most of his teeth in his lower jaw to a combination of diabetes mellitus and chronic gum disease. The remaining teeth supporting his dental bridge were periodontally weakened and mobile. Desiring a permanent solution, he presented to our hospital for management.
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Premium quality dental implants were placed in his lower jaw after extraction of his remaining teeth. Autologous bone chips were also placed in the extraction sockets. A ceramic dental bridge will be fixed to the implants after osseointegration of the implants to surrounding alveolar bone.

This lady has had long standing facial asymmetry with deviation of the mandible to the left side due to vertical shortening of the ramus on the left and an occlusal cant with resultant malocclusion. She presented to our hospital for correction of her deformity.

She underwent mandibular distractor placement along with a Le Fort I surgery. She subsequently underwent a mandibular distraction of 2 cm after a latency period of seven days. The distractor was removed after consolidation of bone at the distracted site in six months.
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There was establishment of facial symmetry along with correction of the occlusal cant. She was very happy with the results of the surgery.

This young man was born with a unilateral cleft lip and palate deformity, which was surgically corrected as an infant. He presented to our hospital stating that he wanted correction of his nasal deformity as well as the hypertrophic lip scar.

Examination revealed a noticeable depression in the right anterior maxillary region, which caused the right nostril to be depressed. He also had a flattened nasal bridge and a hypertrophic scar on his lip.
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The depression in his right anterior maxilla was addressed using bone grafts harvested at the time of surgery. A costal graft was then utilized to augment the bridge of his nose. This was followed by a lip scar revision surgery as well as a Weir excision for left alar base correction.

This resulted in a symmetrical nasal form and he was very happy with the results of the surgery. He profusely thanked the surgical team before final discharge from the hospital.

This young man had always been dissatisfied with the shape of his nose. He had always felt it was very broad and had a hump. This made him feel depressed and socially withdrawn. His parents therefore decided to seek surgical correction of his nasal deformity.

It was explained to him that a closed rhinoplasty would be performed to correct the imperfections in his nose. There would be no visible scarring from this procedure.

A transcartilaginous incision was made and dissection was done to the lower lateral cartilages. The lateral cruces were excised to reduce the breadth of his nose. Dissection was then done to the dorsum of his nose. His nasal hump was rasped down to give his nose a straight profile.

Bilateral Weir excisions were then performed to reduce the breadth of his alar base. This resulted in a nasal structure that was in harmony with the rest of his face.
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The patient and his parents were very happy with the results of the surgery. They expressed their satisfaction before final discharge from the hospital.

This young lady had been born with a unilateral cleft lip and palate deformity, which had been corrected as an infant. She now has a deformity of the vermillion border as well as asymmetry of the nose. Desiring to get this corrected, she presented to our hospital for management.
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She first underwent correction of the vermillion border deformity, which resulted in symmetrical lips. This was followed by excision of the lower crus of the nasal cartilage followed by bilateral lateral osteotomies.
There was complete symmetry of the nose and lip following surgery. She was very happy with the esthetic outcome and profusely thanked the surgical team.

This young man had been born with a unilateral cleft lip and palate defect, which had been corrected when he was an infant. He now presents with a depressed right alar base arising from a maxillary alveolar bone defect and fistula. Treatment planning was explained to him and he consented to surgery.
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Lyophilized bone grafts were utilized to augment his alveolar bone defect and fistula. The bone graft was then utilized to augment the bridge of his nose through an intercartilaginous incision after excision of the lower part of his medial nasal cartilage.

Bilateral lateral osteotomies were finally performed resulting in esthetic correction of his nasal deformity. He expressed his delight at the result of the surgery.

​This young man had suffered a severe electric burn injury to the left side of his face in a workplace accident. He had undergone a split-thickness skin graft surgery from his thigh elsewhere, but excessive graft shrinkage and colour mismatch had left him distraught and depressed with the results.
 
His family had made widespread inquiries regarding facial cosmetic surgery and had been referred to our hospital for management.
 
Upon examination, there was an unsightly scar at the region of the previous split thickness graft on his left cheek. There was also facial disfigurement due to excessive graft shrinkage. Treatment planning was explained to him and he consented to surgery.
 
He underwent facial reconstruction surgery at our hospital through the tissue expansion technique. A device called a tissue expander was inserted underneath normal skin overlying his left cheek that was adjacent to the scarred area. This device was gradually filled with increments of saline solution thus stretching the overlying skin.
 
Once adequate new skin had been obtained over the device, which perfectly matched the normal skin, the scar tissue was excised and the new normal skin was draped over the region of defect. The patient was extremely happy with the results of the surgery and couldn’t stop expressing his amazement at the cosmetic transformation of his face.

​The patient is a 14-year-old boy who was born with a deformed right external ear. There was just a rudimentary structure in place. He had faced significant bullying in school. One of his greatest wishes in life was to be able to wear sunglasses like his father. His parents’ widespread enquiries for the best surgeon to address this issue led them to our hospital.

​Dr SM Balaji, microtia ear deformity surgeon, examined the patient and obtained detailed measurements of his normal left ear. He explained to the parents that the surgery needed to be performed in two stages. It was further explained that cartilaginous grafts needed to be harvested for the procedure. The parents consented to the procedure

​Under general anesthesia, a costochondral graft with an intact synchondrosis was first harvested from the patient. This was in the form of an ‘E’ in order to recreate the cartilage of the external ear. Using a template created from the measurements obtained from the normal ear, the graft was carved to recreate the external ear form.
Attention was next turned to placement of the costochondral graft at the site of the deformed right ear. A subcutaneous pocket was created followed by insertion of the graft into the pocket. The incision was closed and a period of three months was allowed to elapse before the second stage.

​A full thickness skin graft was harvested from the patient’s inguinal (groin) region. This was followed by incising around the cartilaginous graft and raising up the entire superstructure of the recreated right ear. The skin graft was then sutured to cover the exposed tissue behind the recreated pinna. A period of one month was allowed for full healing of the surgical site.

​The patient and his parents were very happy with the results of the surgery. He was now able to realize his long-cherished dream of wearing sunglasses like his father. His earlobe had also been perfectly recreated. They expressed their profuse gratitude to the surgical team before final discharge from the hospital.

​This middle aged lady first noticed the swelling on her anterior left mandible two years ago. This was followed by loosening of teeth in the region. A local dentist had obtained an x-ray and diagnosed this to be a cystic lesion with an impacted tooth. He had attempted removal of the cyst; however, this had not resolved but had got infected. 

​Dr SM Balaji, jaw reconstruction specialist, examined the patient and obtained a biopsy. Biopsy confirmed this to be a dentigerous cyst. He advised resection followed by reconstruction with rib grafts and rehabilitation with dental implants.
 
The patient consented and subsequently underwent successful jaw reconstruction with rib grafts. She was advised to return in three months following bony consolidation of rib grafts with alveolar bone.

​The patient returned for dental implant placement after three months. Four Nobel Biocare dental implants were placed in the well consolidated alveolar bone. The patient was then instructed to return in four months to allow for implant osseointegration with bone.
 
Upon returning after four months, a ceramic bridge was fabricated in our in-house dental laboratory for the patient. Her bridge was then cemented to the implants to complete her rehabilitation.

​The patient expressed her complete satisfaction at the overall treatment experience at our hospital. She thanked the surgical team for her successful rehabilitation before discharge from the hospital.

This young man was riding his bike to work when the signal turned red. He braked suddenly, which caused the car that was tailgating him to rear end his bike. This sudden impact caused him to lose his balance and fall directly on his chin. Of note, he was not wearing a helmet at the time of the accident. There were some minor bruises and lacerations, but what caused him great alarm were the grating noises he heard upon attempting to open his mouth and speak.

Realizing that something was not right, onlookers at the site of the accident informed his parents over his mobile phone and took him to a nearby hospital for treatment. Doctors at the hospital administered first aid with thorough debridement of his lacerations due to the presence of road dirt. He was also administered a tetanus toxoid to avoid the possibility of tetanus.

His parents had reached the hospital by then and they were informed that their son had multiple fractures to his lower jaw. They referred the patient and his parents to Balaji Dental and Craniofacial Hospital as it is renowned for facial fracture surgery in India. Many patients with fractures of the jaws are referred to us because we are a specialty jaw fracture surgery hospital.

Dr SM Balaji examined the patient and ordered imaging studies upon their arrival at the hospital. This revealed that the patient had a displaced fracture of the body of the mandible on the left along with a nondisplaced ramus fracture on the right. He also had a fractured lower left second premolar tooth.

All the findings were explained to the patient and his parents. It was advised that he emergently undergo open reduction and internal fixation of the two fractures with titanium plates and screws along with extraction of the fractured tooth. They were also informed that his jaws would be wired shut for a period of 2-3 weeks following surgery to allow for the bones to be held stable during the healing period. They were in complete agreement with the treatment plan and signed the written informed consent for surgery.
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The patient was taken to the operating room and placed under general anesthesia. The fracture sites were accessed through intraoral incisions to avoid any visible scars on the patient’s face from the surgery. The fractured tooth was then extracted.

The displaced body of the mandible fracture was addressed first. The fractured segments of the mandible were stabilized and fixed using titanium plates and screws. A similar procedure was then performed on the right ramus fracture. Correct occlusion was ascertained before fixing the fracture with the titanium plates and screws. The patient’s jaws were then wired shut using Intermaxillary fixation.
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The patient was advised to stay on a liquid diet until his jaw wiring was removed and to stay on a soft diet for a further fortnight after that. Surgical results were excellent and the patient and his parents expressed their complete satisfaction at the results of the surgery.

A 14-year old boy

A 14-year-old boy form Meghalaya came to our hospital with a complaint of difficulty in breathing and facial swelling. The patient complained that he felt a heaviness in his face. The parent’s described that the swelling was growing in size. They requested for immediate correction of the swelling.

Fibrous dysplasia

Fibrous dysplasia is a disorder where normal bone and marrow is replaced with fibrous tissue. This results in the formation of weak bone. Thereby leading to expansion. It may result in fracture and can cause bone deformity. Certain people may feel pain associated with fibrous dysplasia. Functional impairment can also occur. Fibrous dysplasia is not cancerous but may pre-dispose to cancer in about 1% of the population.

Treatment of choice

As such, there is no cure for fibrous dysplasia other than symptomatic treatment. A fracture is treated if evident. Bony expansion is treated surgically. Fibrous dysplasia may require cosmetic correction depending on the position and the size of the lesion.  In this case, fibrous dysplasia was involving the maxilla, zygoma, floor of the orbit and nasal cavity. Thereby, causing functional impairment.

Investigations

Thorough clinical, radiological and histopathological examination done. A biopsy was done. The biopsy results revealed fibrous dysplasia. CT scan revealed fibrous dysplasia involving the maxilla, zygoma, nasal cavity and extending up to the orbital floor. Maxillofacial surgeon Dr.S.M.Balaji planned to resect the entire fibrous tissue.

Procedure

Incision placed Intraorally. Mucoperiosteal flap elevated. The entire fibrous bone was resected and burred down completely. It was also made flush with the surrounding bone. The surgery was a great success.

Results

The patient was able to breathe well after the surgery. He no longer felt a heaviness in his face. He expressed his joy after the surgery. He stated that his face felt lighter than before. The entire procedure was done intra orally and hence there was no scar on the face.

She presented with a complaint of backwardly placed upper jaw. This gave her an aged look. She was also unhappy with her face. The patient wanted to have a more pleasing face. She was unable to bite and chew food.

A local dentist had mentioned that her upper jaw was small at a young age. He stated that she will have orthodontic problems in the future. He started noticing the difference when she was in a mixed dentition period. He had suggested that she would require orthognathic surgery at a later age or risk developing jaw joint pain.

He had reviewed her at about 18 years of age. During which he noticed that she did not have a proper bite relationship. The upper and lower teeth were completely malaligned. She had a lot of dental issues. There was also a noticeable anterior crossbite. The roof of her mouth was normal after surgical correction of cleft palate.​

​She had an abnormal bite. The upper and lower jaw was in an abnormal position. Every single tooth including the upper molars was also abnormally placed. She had an anterior and posterior crossbite. This is also known as a complete crossbite. The patient had a more curved facial profile. Her profile was concave. This showed that she needed advancement of the maxilla.

​Radiological evaluation revealed backwardly placed upper jaw. This was due to restricted growth of maxilla. The growth of mandible was normal. Since the maxillary jaw growth was restricted, the mandible looked longer. The upper front teeth were placed inside the lower front teeth.

​Maxillofacial surgeon Dr.S.M.Balaji advised upper jaw surgery by bringing the maxilla forward.   Maxillary advancement was planned by Le Fort I osteotomy. The segment was to be fixed using Ti plates and screws. An incision made in the maxilla. Flap elevated. Bone cuts made above the apices of the teeth. Pterygomaxillary dysjunction done.  The maxillary segment was mobilized. The maxilla was pulled forward. It was brought in occlusion and fixed using Titanium plates and locking screws (Ti L plate). The maxillary vestibular region was sutured.

​The patient was greatly satisfied with the results. The surgery was successfully performed. The maxilla was successfully brought forward. The anterior crossbite and posterior crossbite was corrected. The patient will, however, require post-surgical orthodontic treatment for minimal teeth alignment.

A 3-month old baby boy born with unilateral cleft lip & palate was brought to our hospital by his parents seeking the best treatment for cleft lip and palate. The parents were perturbed after seeing their firstborn son’s condition.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary repair surgery for unilateral cleft lip using Modified Millard’s technique. Following surgery, the baby appeared to be like any other baby of his age with minimal to no scar. The parents were greatly pleased with the results. Consecutively cleft palate correction surgery will be done.

A 4-month old baby boy born with unilateral cleft lip & palate was brought to our hospital by his parents seeking the best possible treatment for the cleft defect. The parents were greatly depressed and complained about the difficulty in feeding him.
Under the expert care of Cranio-Maxillofacial Surgeon Dr. S.M. Balaji, the primary lip repair surgery for unilateral cleft lip was carried out using Modified Millard’s technique. Immediately post surgery, the baby’s appearance improved greatly and he was able to feed well. The parents were very glad about the results and were thrilled as their baby had hardly any post-surgical scars. Cleft palate correction surgery will be done at a later date. 

​This is a case of macrostomia (lateral facial cleft) in a 1 year old baby girl from Siliguri. The parents brought the baby seeking the best surgical treatment for the correction of wide mouth and the asymmetric appearance of the baby without much visible scars on the face.
Surgical correction of macrostomia is challenging and more complex as it aims in restoring back the normal appearance while at the same time maintaining the normal functions like speech, blowing, etc.
Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected the macrostomia using vermillion return flap technique. Results are immediate and the parents feel very happy to see the negligible scar formation, following suture removal.

Successful reconstruction of the upper lip attempts to maintain the anatomic and physiological relationship of the philtrum (central portion of upper lip) and the base of the nose.

This is the case of secondary cleft lip and nose deformity in a 22 year old boy from Nepal. He is a known bilateral cleft lip and palate patient where the primary cleft lip and palate surgeries where done elsewhere in his hometown. He had defective appearance of the nose and lip due to which he lost his self confidence and he was very conscious about the appearance.
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Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected both the nose and lip defect together using Abbe flap technique. In the first stage a flap of tissue was taken from the lower lip, rotated across the lips and used to reconstruct the thin central portion of the upper lip, with the base of the flap still attached to the lower lip. Simultaneously in the same procedure itself, reduction rhinoplasty was done to correct the broad nose. After blood supply was established in a few days, the second stage surgery to divide the flap was done. The defect was corrected giving the upper lip a more natural, enhanced form. Results are immediate, both the nose and upper lip defect are corrected giving improved appearance and this boosted the boy’s confidence.