Maxillofacial Surgeon Prof. S.M. Balaji successfully performed the cleft palate repair. In the palatal pushback technique, a palatal flap was raised. The abnormally attached palate muscles were detached & reattached like a hammock in a correct position. A 2–layered closure – of the nasal and oral floor was done. Further cleft management will be done subsequently.
A 11-month old baby girl was brought to our hospital by her parents for cleft palate repair. She was born with unilateral cleft lip & palate. She was operated for primary cleft lip repair when she was 3 months old. Maxillofacial Surgeon Prof. S.M. Balaji successfully performed the cleft palate repair. In the palatal pushback technique, a palatal flap was raised. The abnormally attached palate muscles were detached & reattached like a hammock in a correct position. A 2–layered closure – of the nasal and oral floor was done. Further cleft management will be done subsequently.
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A 10-month old baby girl born with unilateral cleft lip and palate was brought to our hospital by her parents for cleft palate repair. She was previously operated for primary cleft lip repair few months ago. Maxillofacial Surgeon Prof. S.M. Balaji successfully performed the cleft palate repair using palatal pushback technique. A palatal flap was raised on right & left side and abnormally attached palate muscles were detached & reattached in a normal position like a hammock. The nasal floor & oral floor were closed in two layers. Following surgery, positive suction test was seen indicating successful palate repair surgery. 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 remarkable 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 months baby girl born with unilateral cleft lip and palate was brought to our hospital by her parents for surgical correction of cleft lip defect.
Maxillofacial Surgeon Dr. S. M. Balaji skillfully corrected the unilateral cleft lip defect by following Modified Millard’s technique. Results are immediate and the baby’s parents were happy to see the surgical correction done without much scars. Enhanced post operative view immediately after suture removal following seven days of surgery was seen. A 10-year-old boy was brought to our hospital by his parents for reconstruction of his alveolar cleft. He was previously operated for cleft lip and cleft palate in his childhood. On his parents’ request he was planned to undergo bone graft surgery. Maxillofacial Surgeon Dr. S.M. Balaji grafted bone from the boy’s hip region and the harvested bone was jam packed in the cleft to completely close the defect. Closure of alveolar cleft defect either by bone graft or BMP will ensure proper eruption of permanent teeth. Further cleft management will be done subsequently. A two-month-old baby boy born with unilateral cleft lip and palate was brought to our hospital by his parents for comprehensive management of the cleft deformity.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction using Modified Millard’s technique. Following surgery the baby’s appearance improved remarkable and he was able have milk without much difficulty. The baby’s parents are very happy with the surgery outcome. Cleft palate repair will be done subsequently. A 3 months old boy baby with incomplete cleft lip was brought to our hospital by his parents for correction of his cleft lip defect. Maxillofacial Surgeon Dr. S. M. Balaji skillfully performed the primary cleft lip repair by following Modified Millard’s technique. Results are immediate and the parents were very happy to see their boy with complete correction of cleft lip without much surgical marks. A 1-year-old baby girl born with isolated cleft palate was brought to our hospital by her parents for expert treatment of the cleft defect. The baby’s cleft palate defect was classified as Millard’s 10 and 11. Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the cleft palate correction with palatal pushback technique. A palatal flap was raised on both right and left side. The Levator palatine muscle was detached from their abnormal positions and reattached to its normal position like a hammock. A two layer closure – closure of nasal floor and oral floor - was done. Cleft palate repair was successful and results were immediately seen with a positive suction test where the soft palate muscles move upwards due to the vacuum created in the nasal passage with the suction that ensures improved speech A 15 year old boy with unilateral cleft lip and palate reported to our hospital with the complaints of asymmetrical nose and depressed nostril on the right side due to huge cleft defect. And he wants to correct his jaw alignment where the lower jaw is prognathic due to which he was not able to bite and chew any hard food stuffs. Defective nose profile reduced his self confidence considerably. Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his cleft nose defect as well as the jaw alignment simultaneously. Cleft nose defect was corrected with columellar strut graft harvested from the ribs, through intraoral approach and shape of the ala was maintained. Also alar base was raised with the graft. Skeletal malocclusion correction was done by subapical osteotomy and thus skeletal cross bite was corrected. Patient and his parents were happy to have both the defective nose and bite correction done simultaneously without any scars on the face. Results are immediate. A 2-month old baby girl from Maldives born with unilateral cleft lip and palate was brought to our hospital by her parents for cleft treatment.
Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the primary cleft lip repair using modified Millard’s technique. Following surgery, the baby’s appearance & feeding improved greatly. The baby’s parents were very happy that the surgery caused no scars on the face. They have gone back to their homeland and will return subsequently for cleft palate surgery. A 12-year-old boy born with isolated cleft palate was brought to our hospital by his parents for surgical speech correction. He was previously operated elsewhere multiple times for his cleft palate defect. He had a nasal twang in his speech. This condition is called velopharyngeal incompetence that occurs in cleft children due to escape of air through the nose while speaking. Maxillofacial Surgeon Dr. S.M. Balaji expertly performed a dynamic sphincter pharyngoplasty surgery wherein the palato-pharyngeal muscles were criss-crossed to correct the velopharyngeal incompetence. The video shows the new dynamic velopharyngeal sphincter action and a positive suction test indicating successful correction of velopharyngeal incompetence. An 18-year-old boy reported to our hospital seeking to correct his cleft nose defect that affected his appearance. He was operated elsewhere in his childhood for bilateral cleft lip and palate. Due to the cleft defect his nose was deformed and beak shaped. Maxillofacial surgeon Dr. S.M. Balaji skillfully performed the cleft rhinoplasty. A costochondral cartilage graft was harvested and the dorsum of the nose was augmented using the graft. The prominent lower lateral nasal cartilage was removed on both sides to correct the ala defect and reconstruct the structure of the nostrils. The surgery was done from inside the nose so there was no scar. Immediately after surgery, the nose appeared sharp and defined and the boy was very happy with the scarless results. A 30-year-old woman reported to our hospital seeking expert treatment to correct her nose deformity to improve her appearance. She was previously operated elsewhere for unilateral cleft lip & palate. Also nose correction was done elsewhere but the results were esthetically disappointing and excessive contraction of the scar led to severe constriction of the left external nostrils. Her flattened nose was collapsed on the left side making her face look unattractive. Maxillofacial surgeon Dr. S.M. Balaji skillfully performed the rhinoplasty. A nasolabial flap was raised and used to reconstruct the severely constricted external nostrils by shaping the left ala of the nose. A costochondral rib graft was harvested and used to reconstruct the dorsum giving the nose a sharp, defined form. Following surgery, the patient was very happy with her enhanced appearance without any scars on the face. A 12 year old boy with bilateral cleft lip and palate reported to our hospital with the complaints of defective upper lip and ill-defined nose tip with depressed nasal bridge. His parents were not happy with the boy’s appearance and he was not able to spell few words due to defective upper lip which made him more depressed. Maxillofacial Surgeon Dr. S. M. Balaji skillfully planed to correct his upper lip defect as well as his ill- defined tip of the nose by following Abbe flap technique. Surgery was done in two stages. In the first step, prolabium was raised to increase the columellar length and nasal tip projection. And the cleft lip defect was corrected with Abbe flap technique were lower lip tissue was raised and attached to the upper lip defect region. In the second step, achieving good healing after 25 days the upper and lower lip was surgically separated and thus nose as well as lip defect correction was done simultaneously without many surgical scars. The boy and his family was very happy to see the enhanced appearance of the nose and well aligned upper and lower lips without any surgical scars. A 3-year-old Maldivian boy was brought to our hospital by his parents for expert surgical treatment of his cleft deformity. The boy was born with bilateral cleft lip and palate. He previously underwent cleft lip & palate repair at a hospital in Trivandrum. The treatment done there was grossly incorrect resulting in a terrible defect. The upper lip got fused with the gums of upper front teeth. The labial vestibule or gap between the upper lip and gums of teeth was completely obliterated. Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the upper lip and alveolus reconstruction. Preserving the blood supply, the lip and alveolus was successfully separated and reconstructed to create the labial vestibule. Pre-maxillary setback was done using Paul Black technique. Following surgery and suture removal there was good healing. The boy’s appearance, speech and eating improved significantly. The boy and his family were very happy with the defect correction and went back to their hometown and they are to return for further cleft management. A 6 year old boy with bilateral cleft lip and palate was brought to our hospital with the complaints of escape of food and water to the nose while eating and slurred speech due to escape of air to the nose through the hole in the teeth bearing region of the upper jaw. Primary cleft lip and palate repair was done elsewhere. After thorough clinical and radiographic examination Maxillofacial Surgeon Dr. S. M. Balaji diagnosed that in the previous cleft surgery the Surgeon has removed the premaxilla completely along with the developing tooth buds. Thus a part of alveolus along with the few teeth was missing which led to huge cleft defect in the midline of the upper jaw bone. Dr. Balaji skillfully planned to close the cleft alveolar defect with the miracle protein rhBMP-2. A gingivomucoperiosteal flap was raised and the cleft defect was exposed and miracle protein rhBMP-2 was placed in the alveolar cleft defect region and the flap was approximated with sutures. This protein helps the body’s own cells to form new bone at the site of placement. After 3 months achieving complete union of the segmented alveolar bone into a single complete maxilla, replacement of missing teeth followed by orthodontic treatment will be planned. A 1.5 year old boy with isolated cleft palate was brought to our hospital for the surgical closure of the gap (cleft) in the roof of the mouth (palate). The boy’s cleft palate defect was classified as Millard’s 10 and 11. Maxillofacial Surgeon Dr. S. M. Balaji surgically corrected the cleft palate using palatal pushback technique. Incision was made in the mid- vomerine region. The palatal flap was raised on both right and left side. The Levator palatine muscle was detached from their abnormal positions and reattached to its normal position like a hammock. A two layer closure was done. The nasal floor was closed with the vomerine flap making a reverse knot. Oral layer was sutured by vertical mattress sutures. Results are immediate and the suction test was positive which ensures improved speech. Suction test positive guarentees improved speech A 22 year-old-girl born with unilateral cleft lip and palate reported to our hospital seeking expert treatment for her cleft nose defect. Due to the cleft, the left side of her nose was deformed which affected her appearance and she wanted to correct her facial profile.
Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the cleft rhinoplasty. The left ala of the nose was severely depressed. Costo-chondral cartilage was harvested and shaped to reconstruct the nasal framework. Through an intranasal approach the depressed left ala was lifted up by placing the shaped graft. The cartilaginous strut graft was positioned between the medial crura to reconstruct the base of the nose. Immediately after the surgery the shape and appearance of the nose improved greatly. Also since the surgery was done from inside the nose, there were no scars. The girl was very happy with her improved appearance & facial profile. A girl with unilateral cleft lip and palate was brought to our hospital by her parents with the complaints of mal aligned teeth and escape of water through the nose due to the cleft defect. Primary cleft lip and palate repair was done elsewhere. Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct her alveolar cleft defect using iliac bone grafting technique according to her parents’ request. With very minimal incision line in the hip region, the iliac crestal bone was successfully harvested. The incision made was approximated in such a way resulting in very minimal scarring. The harvested graft was placed in the alveolar cleft defect region and approximated to the extent of defect. Patient was comfortable to have a very minimal incision mark left after surgery in her hip region resulting in good healing with very minimal scarring. Her parents were also happy to have her daughter to feel comfortable after surgery. They returned to their home place and were asked to come for further follow-ups and cleft management. A 15 year old boy with unilateral cleft lip and palate from Tirupur reported to our hospital wanting to correct his nose and alignment of his teeth. Primary lip and palate repair was done in his hometown itself during his childhood. He and his parents were more upset regarding his scar results after lip repair which affect his moustache growth as well as his broad asymmetrical nose made his face look disproportionate. Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his cleft defects to overcome the future growth huddles. Considering their level of distress they had in the results of previous surgeries, multiple cleft defects were planned to be corrected in a single surgery. Deviated nasal septum was aligned through intra oral approach using chondral graft obtained from his rib. Thus his nose defect was shaped to normal shape and size. His cleft alveolar defect was closed with miracle protein rhBMP-2. His lip defect which was due to incorrect approximation of mucosal flaps leaving the vermillion of the lip defective. Thus, vermillion defect was corrected and scar formed due to incorrect technique was removed precisely with very minimal scar formation. Results are immediate showing enhanced appearance of his face due to pristine nose correction and scar revision. A 4-month old baby girl born with unilateral cleft lip & palate was brought to our hospital by her parents seeking the best treatment for cleft defect.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary repair surgery for unilateral cleft lip using Modified Millard’s technique. Following surgery, the baby’s appearance improved greatly and she was able to feed well. The parents were very happy that their baby had hardly any post-surgical scars. Consecutively cleft palate correction surgery will be done. A 3 month old baby boy born with unilateral cleft lip and palate was brought to our hospital by his parents for surgical rehabilitation of cleft deformity.
Maxillofacial Surgeon Dr. S. M. Balaji performed the primary cleft lip repair using Modified Millard’s technique. His parents were very happy that their boy’s lip defect was corrected with very minimal scar and the appearance improved greatly. The baby with his family went back to their home place and they are to return for further cleft management. Successful macrostomia correction with alveolar cleft defect repair using miracle protein rhBMP-221/3/2014 A girl born with unilateral cleft lip and alveolus defect along with macrostomia was brought to our hospital by her parents for surgical correction. Macrostomia is a rare type of facial cleft deformity in which the mouth is unusually wide. In this case, the girl had both alveolar cleft defect and abnormally wide mouth causing a gross distortion of her facial appearance. Maxillofacial Surgeon Dr. S.M. Balaji skillfully corrected the alveolar cleft defect and macrostomia in a single surgery. Alveolar cleft defect was closed with miracle protein rhBMP-2 and macrostomia was corrected by approximating the adjacent facial muscles. The defect was closed in layers and the lip was made more natural by maintaining the height and contour using the vermillion return flap technique. The girl’s parents felt very happy as both large mouth and cleft repair surgery was combined and post operatively scars were very less. Sixteen years ago, a 4-month-old baby girl born with unilateral cleft lip & palate was brought to our hospital by her parents for the complete rehabilitation of her cleft deformity. Maxillofacial Surgeon Dr. S.M. Balaji performed the successive surgeries over the years.
Primary cleft lip repair surgery was done when the baby was 4 months old and palate repair surgery was done at 8 months of age. When the baby was 6 years old, rhBMP-2 surgery was done to treat the alveolar cleft defect. Miracle protein rhBMP-2 was placed in the cleft of the teeth bearing region of the upper jaw to completely heal the bony defect avoiding bone graft. Now the girl reported to our hospital seeking to enhance her facial profile. She had a hypoplastic maxilla (retruded upper jaw) and she was not happy with her appearance. Dr. Balaji performed the intraoral maxillary distraction osteogenesis whereby the upper jaw was advanced and aligned properly with the lower jaw. This was done completely inside the mouth so there were no scars. Using distraction & orthodontics, her appearance & facial profile was greatly enhanced. An 8-month-old baby girl from Africa, born with unilateral cleft lip & palate, was brought to our hospital by her parents for the surgical correction of her lip defect.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary lip repair surgery using the Modified Millard’s technique. The baby’s parents were very happy that their baby’s lip defect was corrected with hardly any scars and the child’s appearance greatly improved. The baby and her family went back to her homeland and they are to return later for further cleft management. |
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