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 This made him feel depressed and socially withdrawn.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.

This patient reported to me with the complaint of facial swelling for past 5 months which became noticeable for last 10 days. After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as Odontogenic keratocyst (OKC) involving the entire left body and anterior region of the mandible.
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Surgical treatment was planned to remove the entire cystic lesion and reconstruct the affected jaw portion in a single stage. Costal rib graft was harvested for the reconstruction of the mandible. Through intraoral approach, crevicular incision was placed in the mandibular anterior teeth region extending posterior till mandibular notch, gingivomucoperiosteal flap was raised, cystic lesion was surgically exposed and the affected portion was removed along with the involved teeth in toto and reconstruction was done using long titanium bone plate and costal graft maintaining the contour of the mandible. After successful graft uptake, dental rehabilitation will be done using dental implants in the newly formed bone.

This is the case of post traumatic secondary facial deformity in a 25 year old boy from Kolkata. He gave a history of RTA 3 years back and had first aid, primary reconstruction surgeries elsewhere.
On examination, he had defective left eye prosthesis and deformed nose. He was very conscious about his looks and lost his confidence due to the defective appearance. 
Maxillofacial Surgeon Dr. S. M. Balaji surgically corrected the defective appearance of the boy without much visible scars on his face. The defective eye prosthesis was removed and orbital content was reconstructed using buccal tissue graft and silicone orbital implant. Artificial eye prosthesis in close resemblance to that of the right eye was fixed. This improved his overall appearance. Through the previous scar, defective ala of nose was corrected using chondral graft obtained from the rib cartilage. The boy is very happy for the successful facial reconstruction. This helps in regaining his self confidence.  

A 3-month-old baby boy born with bilateral cleft lip and palate was brought to our hospital by his parents from Mauritius for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery by following Paul Black’s technique to correct the lip enabling the baby to feed well.  Subsequently cleft palate surgery will be done to completely rehabilitate the child. 

A young man from Singapore reported to me with the complaint of huge swelling in the right side of his face. He added that the size of the swelling was increasing progressively which made his face asymmetrical. He was very cautious about this progressive swelling. Added he had histopathological examination of the intraoral tissue done elsewhere diagnosing as plexiform ameloblastoma.
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After thorough clinical and radiological examination, Maxillofacial Surgeon  Dr. S. M. Balaji planned to remove the lesion and reconstruct the affected jaw portion in a single stage. Intraorally, complete removal of the benign lesion with sufficient clearance of the bone was done following rib graft which was obtained was fixed to it. Patient was happy to have both removal and reconstruction in a single surgery.

This is a case of 3 months old baby boy with incomplete bilateral cleft lip from Bangladesh. Maxillofacial Surgeon Dr. S.M. Balaji surgically corrected the cleft lip defect by following Paul Black's technique. Results are  immediate. Immediate postoperative view following suture removal shows negligible scar formation.  ​

A 30-year-old man from Bangladesh was suffering from severe pain and swelling in his right side of lower jaw. He also complained of difficulty to open his mouth wide and bite and chew foods. He was advised by his family doctor in his home town to go to Balaji Dental and Craniofacial Hospital at Chennai, India, for specialized treatment.

Maxillofacial Surgeon Dr. S.M. Balaji thoroughly evaluated his jaw defect clinically and using advanced 3D CT scan. The scan images showed that he had multiple and extensive areas of bone loss that appeared to resemble large cystic tumors involving the almost entire right side of lower jaw.
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Biopsy of the lesion was done which proved it to be odontogenic keratocysts. Dr. Balaji planned a complete reconstruction of the lower jaw right side, using the man’s own rib graft. The affected portion of the lower jaw bone was surgically removed. Diseased portions of the bone were completely and thoroughly removed to ensure that there is no recurrence. A costochondral cartilage graft (rib graft) was taken and used to reconstruct the lower law. The man feels very happy for the surgery outcome and the entire surgery was done intra orally avoiding external scar formation.
4 months follow-up
4 months postoperative digital OPG and 3DCT shows good bone formation. Dental implants fixed in the newly formed bone with good stability and retention.

A 3-months-old baby boy born with unilateral cleft lip and palate defect from West Bengal was brought to our hospital by his parents for surgical correction of cleft lip defect.
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Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the cleft lip repair using modified Millard’s technique.  The baby’s appearance was remarkable improved and he was able to feed well. His parents feel very happy to have the cleft lip treated with negligible scar formation.

​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.