A 27-year-old man from Kolkata reported to our hospital seeking expert craniofacial reconstruction. He had met with a vehicular accident few months back and suffered fracture of the forehead, cheek bones & lower jaw. He underwent initial surgery elsewhere. He had a gross skull defect with a depression in his left forehead. He also complained of continuous tears running down his face from his left eye.

3D CT scan revealed fracture of the frontal bone on the left side. Due to the traumatic injury, a defect in the nasolacrimal duct caused epiphora or abnormal tear flow. The normal flow of tears from the eye to the nose was damaged.

Craniofacial surgeon Dr. S.M. Balaji skillfully performed the complex reconstruction. A cortical bone graft was harvested from the rib and used to reconstruct the left forehead. Miracle protein rhBMP-2 was placed on the bone graft to stimulate new bone formation.

The defect in the nasolacrimal duct was corrected with DCR or Dacryocystorhinostomy. The ostium was opened with rongeurs, bone adjacent to nasolacrimal sac was removed. A new direct communication was created between the nasolacrimal sac & the nasal mucosa by placing a silicone tube to enable the tears to drain into the nose. Complete craniofacial defect was corrected successfully.

A 40 year old man reported to our hospital with the complaints of huge swelling in the left side of face. He gave the history of previous surgery done elsewhere, were they have removed a tumor extra orally but it got recurred. He also explained about the nature of swelling as he had noticed the swelling 2 years back. But the swelling was small at that time, later it started to grow slowly and extended to the present size now. Initially he had tenderness in the cheek region, but later there was no pain.

After thorough clinical and radiological examinations, it was diagnosed as recurrent Neurofibroma. Maxillofacial surgeon Dr. S. M. Balaji skillfully planned to remove the tumour completely as well as to reconstruct his face. Through the previously operated nasolabial scar, the tumor was exposed by raising the infra orbital skin. Tumor was separated from the maxilla and zygomatic bone and removed completely. Tumor was adherent to the previously operated site which was also detached and removed completely.

The ectropion (turning out of the lower eyelid) in the left eye was repaired with lateral canthotomy incision and orbital septal return flap technique. The inferior tarsal plate was sutured with supra orbital periosteum. Excess skin in the nasolabial area was excised and wound closed in layers.

A 34-year-old lady reported to our hospital with a complaint of continuous tears running down her face from her left eye. She gave a history of having met with a car accident.  Due to the traumatic injury, it was identified that the medial canthal ligament of her left eye had detached and come down. A defect in her nasolacrimal duct caused epiphora or abnormal tear flow. The normal flow of tears from the eye to the nose was damaged.

The aim of the surgery was to correct the defect in the nasolacrimal duct with DCR or Dacryocystorhinostomy & reposition the medial canthal ligament. The ostium was opened with rongeurs, bone adjacent to nasolacrimal sac was removed. A new direct communication was created between the nasolacrimal sac & the nasal mucosa by placing a silicone tube to enable the tears to drain into the nose. The medial canthal ligament was repositioned using Y-plate canthopexy.