Maxillofacial Surgeon Dr. S.M. Balaji performed the clinical and radiological investigations. OPG and 3D CT scan showed complete absence of left side angle and ramus of mandible with remnants of bone graft. Dr. Balaji successfully reconstructed the huge mandibular defect maintaining the contour using titanium “L” plate and costochondral rib graft and thus missing condylar component was also reconstructed, the surgical site was closed. Patient feels very happy to have entire surgery done inside the mouth and to have complete facial asymmetry correction without any scars on the face.
A 32 year old woman came to our hospital for expert treatment for her lower jawbone defect. She gave the history of huge odontogenic keratocyst lesion involving left mandibular angle and ramus along with the entire condylar component was removed extraorally and reconstructed using costochondral rib graft elsewhere. But the graft got infected and removed and reconstruction plate was fixed. Later plate was broken and was removed. Her complaint was jaw deviation towards left side and facial asymmetry. Also she wants to correct her facial appearance without any scars on the face. Maxillofacial Surgeon Dr. S.M. Balaji performed the clinical and radiological investigations. OPG and 3D CT scan showed complete absence of left side angle and ramus of mandible with remnants of bone graft. Dr. Balaji successfully reconstructed the huge mandibular defect maintaining the contour using titanium “L” plate and costochondral rib graft and thus missing condylar component was also reconstructed, the surgical site was closed. Patient feels very happy to have entire surgery done inside the mouth and to have complete facial asymmetry correction without any scars on the face.
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Complete smile makeover following successful jaw reconstruction & dental implants for African boy28/5/2016 A young African boy from Nigeria suffering from Ectodermal Dysplasia was referred to our Hospital for expert care. He had multiple missing teeth & had previously undergone bone grafting elsewhere but the graft had already resorbed & failed. Maxillofacial Surgeon and Dental Implantologist Prof. Dr. S.M. Balaji performed the complete jaw bone reconstruction using costochondral rib graft . Implants were placed to replace his missing teeth. Following osseointegration of the implants, cosmetically well blended fixed ceramic prosthesis was given enhancing the appearance. A 16 -year-old girl reported to our hospital seeking specialized treatment to correct her cleft nose defect. She was previously operated for cleft lip and palate elsewhere. Due to the cleft defect her nose was collapsed on the left side and it affected her facial appearance. Maxillofacial Surgeon Dr. S.M. Balaji expertly performed the Corrective rhinoplasty or nose correction. A costochondral graft (rib graft) was harvested and used to reconstruct the collapsed nasal framework. The surgery was approached from inside the nose so there was no scar. Secondary lip repair was also done to correct the vermillion defect. Immediately after surgery, the nose appeared sharp and definite giving a more pleasing appearance. The patient was very happy to have her nose defect corrected without any visible surgical marks on the face. GROWTHÂ CENTERÂ TRANSPLANTATION USING COSTOCHONDRAL RIB GRAFT FOR BILATERAL TMJ ANKYLOSIS CORRECTION19/5/2016 A 6 year old boy was brought to our hospital with a complaint of decreased mouth opening and facial deformity. No history of trauma elicited by his parents. Extra oral examination revealed severely retruded mandible, flattened lower face and complete restriction in mouth opening. OPG revealed obliterated right joint space elongated coronoid process, reduced ramal height and prominent antegonial notch. The case was diagnosed as true right TMJ bony ankylosis with developing secondary facial deformity. Maxillofacial Surgeon Dr. S. M. Balaji successfully performed gap arthroplasty using temporalis flap interpositioning. Followed by active physiotherapy, mouth opening improved dramatically. But patient failed to be on regular follow up. After 9 years, exactly at the age of 15, patient reported with the complaint of restricted mouth opening, severe secondary facial deformity and retruded chin giving bird face appearance. On thorough clinical and radiological examination, it was diagnosed as left TMJ ankylosis with functional right pseudo joint. Dr. S. M. Balaji performed left gap arthroplasty and bilateral condylar component reconstruction using 5th and 7th costochondral rib graft (CCG). Postoperative mouth opening was adequate. Over 8 years follow up, bilateral CCG was favorable and lower facial projection was improved significantly with increased mouth opening. Hemifacial microsomia is a condition in which there is an under-development of one side of the face resulting in facial asymmetry. The affected side of the face appears disproportionately smaller than the other. Characteristically, the lower jaw (mandible), facial soft tissues & musculature, cheek and ear on one side of the face is poorly developed. Sometimes, structural defects in the eye may also be seen. A 28-year-old boy afflicted with Hemifacial Microsomia reported to our Hospital. His lower jaw and ear was under-developed on the right side. He had a slanting bite and an obvious asymmetry of the face. A radiographic examination showed a grossly under-developed lower jaw (mandible) on the right side. There was found to be a bone deformity of about 20 mm. The goal of the treatment is to elongate the deficient jaw bone to restore facial symmetry and correct the slanting bite (occlusion). To achieve this, an advanced and effective treatment technique is distraction osteogenesis. This is a new technique for regenerating new bone by slow, progressive stretching of the bone, without requiring a bone graft. Eminent Craniofacial Surgeon Dr. S.M. Balaji is a pioneer in introducing this revolutionary technique and has successfully rehabilitated the maximum number of patients afflicted with facial disfigurements in the country. In distraction osteogenesis, the jaw bone on the deficient side is cut. A sophisticated device called distractor is placed such that the two arms of the device are fixed to the two segments of jaw bone. After a few days, a screw attached to the distractor is turned gradually, ideally at a rate of 1 mm per day. When this is done, the two cut segments move apart and new bone is formed in the resultant gap. After the required length is achieved and new bone is stabilized, the distractor device is removed subsequently correcting the asymmetry of the face. This is a powerful tissue engineering technique for generating bone for the desired volume. The overlying soft tissues that are deficient also are expanded, therefore along with the underlying bone deformity, the overlying skin and soft tissue defect is also corrected. This is the only procedure to increase the size of the jaw bones after the cessation of actual bone growth. For this patient, Dr. Balaji adopted a stage-by-stage rehabilitation. To correct the jaw deformity, he applied the innovative simultaneous maxillary and mandibular distraction procedure wherein new bone is formed in both the upper and lower jaws simultaneously to restore facial symmetry. A young man came to our hospital seeking corrective jaw surgery to enhance his appearance. His lower jaw was excessively protruding causing an incorrect teeth occlusion that caused difficulties in biting and chewing. Additionally his chin bone was deviated away from the midline giving his face an asymmetric, crooked appearance. Maxillofacial surgeon Dr. S.M. Balaji planned to correct the jaw defect with a combined bilateral Obwegeser’s sagittal split osteotomy and genioplasty. The mandible was set back to correct the alignment and bite using bilateral Obwegeser’s sagittal split osteotomy. With genioplasty, the deviated chin bone was corrected. The procedure was done from inside the mouth so there were no scars. Immediately after this corrective jaw surgery, the man’s appearance was greatly improved and he is very happy with the enhanced aesthetics. Surgical correction of sunken eye due to fibrous dysplasia without much visible scars on the face9/5/2016 This is a 26-old male who sought treatment for his left sunken eye with constant tearing from left eye. He had been diagnosed with a rare bone disease called fibrous dysplasia at the age of 12 years. In this disease, the bone is slowly replaced with fibrous tissue and the growth of the tissue assumes large proportion. For this patient, the disease was limited to only the orbital bone part. As the orbit (eye socket) bones were pressing the eye, 8 years back, a surgery was performed to relieve the pressure on the eyeball. The result of this surgery leads to improper positioning of the eyeball in the eye socket, resulting in sunken misplaced left eye. Also, as a result of the surgery, there was a constant overflow of tears from the left eye. The current treatment plan is to correct, shape the orbit and position the eyeball correctly. All this procedure needs to be performed without affecting the vision and delicate optic nerve. An upper eyelid incision was placed just below the upper eyebrow along previous scars. Through this incision and a sub-ciliary incison, the bone of the upper margin was shaped. All removed bone was carefully salvaged. Through an inferior medial canthus region, the lower eyelid region was approached. In the lower margin, preparation of the bone was done. Eye tissues were carefully dislodged at needed areas. The salvaged bones were placed and screwed. This gave a new, improved frame work for the orbit. The punctum of tear gland were identified. A delicate silicon tube was carefully inserted and the blocks removed. The tube was retrieved through an artificial opening in to inferior nasal meatus in the nasal cavity. By the suturing of the ductal mucosa with the nasal mucosa, the patency is ensured. By this surgery called dacryocystorhinostomy (DCR), the tears are redirected in to nasal mucosa so that there is no excess tear overflow. A modified “Y” medial canthoplexy was performed to ensure the proper positioning of the eye socket and eyeball. This was a customized technique developed at BDCH. This results in perfectly looking eye socket and eyeball. After the procedure, all movements of eye ball indicated that there had been no damage to the functioning of eye, indicating the complete success of the surgery. A 26 year old boy visited our hospital seeking for correction of his facial profile to enhance the appearance. He was under orthodontic treatment for past 2 years elsewhere. But he was not satisfied with the results and thus he wants to have surgical correction of his jaw without any scars on the face. After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S.M.Balaji planned to correct his face by following corrective jaw surgery. He has short upper lip due to vertical maxillary excess which was corrected by Lefort I osteotomy. His profile shows short chin giving round face appearance. This was corrected by augmenting the genium using costochondral rib graft. Thus entire surgery was done inside the mouth and his facial appearance improved dramatically. Patient feels very happy to have the entire facial correction in a single surgery and without any visible surgical marks on the face. A 3-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance. Subsequent cleft palate surgery will be done to completely rehabilitate the child. A 3 month old baby girl was born with unilateral cleft lip and palate. Her parents brought her to our hospital for surgical management.
Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the cleft lip repair using modified Millard’s technique. Following suture removal 7 days after surgery, the baby’s appearance was greatly enhanced. The baby’s parents were very happy to have the cleft lip defect corrected with negligible scar. Successful removal of huge dentigerous cyst in lower jaw along with the impacted canine tooth28/4/2016 A 23 year-old boy came to our hospital with a complaint of swelling with pain in his lower jaw. A digital X-ray took revealed a large cystic lesion extending from anterior teeth to premolar of the mandible with complete erosion of the labial plate and impacted canine tooth. Histopathological examination of the specimen showed it to be a dentigerous cyst. Maxillofacial surgeon Dr. S.M. Balaji expertly removed the entire cystic lesion along with the lining with affected teeth in toto. Following surgery the wound healed well and the patient was happy to be cured of his ailment. A 26-year-old girl reported to our hospital seeking specialized treatment to correct her cleft nose defect. She was previously operated for cleft lip and palate elsewhere in her childhood. Due to the cleft defect her nose was collapsed on the left side and it affected her facial appearance. Maxillofacial Surgeon Dr. S.M. Balaji expertly performed the rhinoplasty or nose correction. A costochondral graft (rib graft) was harvested and used to reconstruct the collapsed nasal framework. The surgery was approached from inside the nose so there was no scar. Immediately after surgery, the nose appeared sharp and definite giving a more pleasing appearance. The patient was very happy to have her nose defect corrected without any scars. A 3 month old baby boy was born with unilateral cleft lip and palate. His parents brought him to our hospital for surgical management.
Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the cleft lip repair using modified Millard’s technique. Following suture removal 7 days after surgery, the baby’s appearance was greatly enhanced. The baby’s parents were very happy to have the cleft lip defect corrected with negligible scar. A 26 year old woman reported to our hospital with the complaint of swelling in the right side of her face. She added that the swelling was increasing in size dramatically and the lower anterior teeth are mobile teeth. She was very cautious about this progressive swelling which made her under huge depression. After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed ameloblastoma extending from right side of the body of the mandible till the other side. Surgery was planned to remove the lesion and reconstruct the affected jaw portion in a single stage. Through gingivomucoperiosteal flap, complete removal of the lesion along with the involved teeth with sufficient clearance of the bone was done under General anesthesia. Costochondral rib graft was harvested and fixed to it. Flap was approximated and sutured. Patient was happy to have both removal and reconstruction in a single surgery. A 35 year old lady reported to my hospital with the complaints of facial disharmony due to road traffic accident happened 1 year back. She said first aid and fractured facial bone correction done in different hospital at her home town. But the outcome of the surgery was not satisfactory. She wanted to correct her face without much scars on her face. After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji planned to correct her face in a single surgery without any scars on her face. Intraorally, maxilla was advanced by Le Fort I osteotomy and mandibular bone plate was removed. Using bicoronal flap the frontal bone correction was done and orbitoparietal portion of skull and glabella depression was augmented using costochondral rib graft. Depressed dorsum of the nose was also augmented using costochondral rib graft. Superior orbital rim was also augmented using rib graft. Thus entire facial rehabilitation was done without any visible scars on the face. Patient and her family were very happy to see her facial transformation. Surgical correction of nose deformities also known as the “Nose Job” requires expertise and experience. The surgeons estimate the type of defect - either excess or deficit of the height, deviations, depressions, slants and abnormally angled noses. The patient’s expectation of his/her nose is understood after careful examination. Shown is a case with of a deficiency of the bridge portion of nose with bulky tip. Note the midlevel of the nasal bone, where there is a deficiency creating a huge impact on the patient’s facial profile. This gives the nose a saddle-shape. 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 graft (rib graft) was harvested, shaped and positioned to improve the aesthetics of the nose. Bulky tip of the nose was also corrected intranasally by removing excessively curved lower lateral nasal septal cartilage. The patient was very happy with the surgery outcome and her enhanced appearance. This is a case of huge dermal scar revision. Due to road traffic accident the patient had a skin abrasion 5 months back. He was very unhappy due to a depression in the lower jaw and upper neck region on the left side with absence of hair growth in the affected region, and a thick scar that was adherent to the underlying bone, which was affecting his appearance. He wished to have the complete scar revision to enhance his facial appearance. Maxillofacial Surgeon Dr. S.M. Balaji successfully removed the thick scar tissue which was strongly adherent to the underlying bone. The depression was reconstructed by the mobilization of platysma and skin by following double layer closure. The patient was happy that his appearance was greatly improved. A 27 year-old man came to our hospital with a complaint of swelling with pain in his lower jaw. A digital X-ray took revealed a large cystic lesion extending from premolar to premolar of the mandible with complete erosion of the labial plate and impacted canine tooth. Histopathological examination of the specimen showed it to be a dentigerous cyst. Maxillofacial surgeon Dr. S.M. Balaji expertly removed the entire cystic lesion along with the lining with affected tooth in toto. Defective portion of the lower jaw was reconstructed using costochondral rib graft and bone protein rhBMP2. Following surgery the wound healed well and the patient was happy to be cured of his ailment. A 22-year-old man reported to our hospital seeking to correct the appearance of his nose. His nose was much flat in the middle portion 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 dorsum of the nose. Defined tip of the nose was achieved by removing the excessively curved portion of lower lateral nasal septal cartilage. The surgery was done from inside the nose (closed rhinoplasty) so there is no scarring. The patient is very happy to have a sharp, defined & pristine nose immediately after surgery, which improved his appearance. 22 year old female, a known case of bilateral TMJ ankylosis reported to our hospital for the surgical correction of lower half of the face. Micrognathic mandible present due to retarded development. She gave the history of TMJ ankylosis release surgery done elsewhere during childhood. After thorough clinical and radiological examination Maxillofacial Surgeon Dr. S. M. Balaji planned to correct the facial asymmetry using internal distraction osteogenesis with maxillomandibular distractor. Bilaterally Paragingival incision was placed over the angle region along the anterior border of ramus. Full thickness mucoperiostal flap was reflected buccally and bone exposed. The direction of the osteotomy cut and positioning of the distractor is the most important as it determines the vector of distraction and this determines the direction of the bone growth. The distractor device was positioned and fixed using screws. Osteotomy is then completed along the medial cortex. Distractor device was checked and wound closure done. Le Fort I osteotomy was completed in maxilla. After a latency period of 5 days, distraction at the rate of 1 mm per day was accomplished and facial asymmetry was successfully corrected. Thus maxillomandibular distraction technique helped dramatically to enhance the facial appearance without any visible scars and taking autobone graft anywhere from the body. Patient feels very happy to have enhanced facial appearance without any scar on the face. A 22-year-old girl came to our hospital wanting to correct the shape of her nose to improve her appearance. She was born with cleft lip and palate for which she was treated elsewhere in her childhood. Now her nose appeared asymmetric, misshapen & flattened and the nostrils appeared collapsed, which made her look unattractive. She was very depressed about her facial appearance. Maxillofacial Surgeon Dr. S.M. Balaji performed the cleft rhinoplasty to correct the nose shape. Rib graft was taken and used to raise the base of the nose through an intraoral approach. Also the height of the columella was increased and the graft was used to reconstruct the alae and nasal dorsum. Immediately following surgery the nose appeared sharp, symmetrical and pristine greatly improving her appearance. The girl is very happy to have an attractive look without any scar. A 28 year old man from Nigeria came to our hospital for expert treatment for his lower jaw defect. He gave the history of surgical removal of cystic lesion which was histopathologically diagnosed as follicular cyst in his lower jaw twice in his hometown and reconstructed with Bio-oss synthetic bone protein. Recurrence of the cystic lesion noted and the swelling was initially small and gradually increased to its present size for a period of 5 months. He was worried for the recurrence and wants to have permanent solution for the same. Maxillofacial Surgeon Dr. S.M. Balaji performed the clinical and radiological investigations. OPG and 3D CT scan showed a large radiolucent lesion extending from the lower left first molar teeth till right first premolar region. Almost entire bone in this portion of the lower jaw was lost. Dr. Balaji successfully removed the cyst completely along with the affected teeth and bone. Rib graft was harvested and the used to reconstruct the jaw bone defect & the surgical site was closed. After subsequent healing, implants & ceramic crowns will be placed for fixed replacement of lost teeth. A 3-month-old baby girl born with unilateral cleft lip and palate was brought to our hospital 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. Right away after surgery the baby’s appearance was extraordinary improved and she 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. A 4-month-old baby girl born with unilateral cleft lip and palate was brought to our hospital 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. Right away after surgery the baby’s appearance was extraordinary improved and she 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. A 3-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery using Paul Black’s technique to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance. Subsequent cleft palate surgery will be done to completely rehabilitate the child. |
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