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Craniofacial Reconstruction of 5-Year-Old Girl has done By  Dr. S. M. Balaji.

8/12/2016

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Preoperative photograph of Jasra. Please note the facial asymmetry.
Customized 3-D stereolithographic models of Jasra’s skull before surgery, frontal view
Customized 3-D stereolithographic models of Jasra’s skull before surgery, left lateral view
Dr. S. M. Balaji operating on Jasra
Mock surgery performed on the customized 3-D stereolithographic models of Jasra’s skull before the actual surgery, frontal view
Mock surgery performed on the customized 3-D stereolithographic models of Jasra’s skull before the actual surgery, left lateral view
An intraoperative photograph of the sonic weld resorbable plates used to fix the medially rotated frontal bone advancement of Jasra’s skull
Jasra, two weeks postoperative, left lateral view
Ms. Jasra is a 5 year old girl who presented to Dr. S. M. Balaji with craniosynostosis with left plagiocephaly.  This had resulted in her having a deformed head.  Plagiocephaly by definition is flattening of one part of the skull, which leads to facial deformity. She had previously undergone cranial/frontal bone reconstruction and orbital rim advancement elsewhere.
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Craniofacial Surgeon Dr. S. M. Balaji decided to proceed with a craniostomy with calvarial reconstruction to correct her deformity. Customized 3-D stereolithographic models were used for presurgical planning.

She underwent the cranial vault reconstruction surgery on October 24, 2016, at Balaji Dental and Craniofacial Hospital, Chennai by Dr. S. M. Balaji as part of the preconference live surgical demonstration prior to the 10th World Cleft Lip, Palate, and Craniofacial Congress.  Dr. Balaji used sonic weld bioresorbable plates for rotation and advancement of the frontal bone complex. This is an essential surgery because not doing this surgery would result in compromise of brain development, which would lead to decreased mental acuity, vision problems, and many other cranial functions.  Sonic weld plates were used instead of titanium plates because they resorb over time thus facilitating normal bone growth and brain development as opposed to the permanent titanium plates, which would require another surgery for their removal.

The parents expressed their appreciation of how Dr. S. M. Balaji was helping in transforming Jasra’s life for the better. Jasra would need facial asymmetry corrective surgeries at a later date.
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Successful surgical removal and reconstruction of the ameloblastoma of mandible

13/4/2016

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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.
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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.
Preoperative OPG showing lesion in the right body of mandible extending to the left side premolar region
Preoperative 3DCT view showing huge osteolytic lesion involving the labial and lingual cortex of anterior region of mandible
Intraoral view showing huge swelling and cortical expansion in anterior region of mandible
Costochondral graft harvested to reconstruct the affected portion of lower jaw
Intraoperative view showing huge bony tumour involving the entire anterior portion of mandible
Gingivomucoperiosteal flap raised and affected portion of the lower jaw was exposed
Resected portion of mandible with the tumour and involved teeth in toto
Wide excision of the benign lesion was done along with the involved teeth in toto
Harvested costochondral graft fixed with the adjacent bone using bone plates
Immediately after suturing
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Total Calvarial Reconstruction for Metopic cranial synostosis (Trigonocephaly)

1/9/2015

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Preoperative view
Note the triangular forehead deformity
Marking for the bicoronal incision
Craniotomy using Advanced, self-stopping, rotatory craniotome
Intraoperative view showing the manner in which bone has been cut
Dissected bone fragment with multiple releasing cuts for future growth
Dissected specimen for reassembly
Fixing of bone fragments using resorbable plates and screws using special screw driver
Assembly of bone fragment
Reapproximated bone fragments with proper positioning
Reorientation of entire skull cap
Post operative view
Picture
Post operative view
A 3 year old girl from Iraq reported with triangular shaped forehead deformity. Patient was evaluated and diagnosed as a case of nonsyndromic trigonocephaly, which is a premature fusion of the bone joint along the middle of the forehead called the metopic suture. As the early fusion of bone does not permit the growth of the brain it will lead to the increased pressure causing cognitive impairment & delayed mile stones. Owing to these dangerous effects with the progressive growth, her parents brought her to our hospital. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed Craniotomy with Total Calvarial Reconstruction with the goal of aligning the midsutural fused area thereby preventing all associated complication.

Using an advanced, self-stopping, rotatory craniotome, the cranium is cut in to several pieces. The entire skull crown is dissected in several pieces and reassembled to accommodate the growth of the brain with suitable repositioning. Then the re-approximated bones are held together by a bioresorbable plate and screws. The specially designed screw driver is used which creates a small electric discharge creating a strong anchorage holding the bone in place. The entire skull cap is reoriented, approximated and fixed. The change in skull is visible in the immediate post-operative period. The usage of bioresorbable screw and plate removes the requirement of a re-surgery to remove the plates.

In future, the brain would be accommodated in the enlarged, spacious cranial vault thus all the dangerous complications have been evaded.
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Successful reconstruction of infected portion of mandible due to sequestrum of failed bovine bone grafting done elsewhere

2/5/2015

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A 30 year old man came to our hospital with the complaints of swelling in right side of face with pain for past 3 months. He gave the history that he had a huge osteolytic lesion involving right side of the mandible which was removed and reconstructed with bovine bone grafting elsewhere. 

Due to graft rejection there was a huge infected cyst with sequestrum (Dead bone) in the involved region of mandible. Intraorally there was an incomplete closure of buccal mucosa where the sequestrum was exposed. After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji successfully removed the dead bone with the infected cyst intraorally and reconstructed the same with costochondral rib graft. Patient feels happy to have both the removal and reconstruction of the infected portion of mandible without any visible surgical marks on the face.
Preoperative 3DCT scan view showing complete destruction of ramus of mandible on right side with infected cyst
Harvested costochondral rib graft used to reconstruct the defective portion of mandible
Infected portion of mandible surgically exposed showing sequestrum of the failed bovine bone graft done elsewhere
After complete removal of the cyst along with sequestrum of the bovine bone graft
Harvested rib graft used to reconstruct the defective portion of mandible
Immediately after suturing
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Complex forehead & cheek bone fracture reconstruction with abnormal tear flow correction

20/6/2014

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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.
Preoperative 3DCT scan view showing fractured frontal bone involving supraorbital rim with commuited fracture of nasal bone on the left side
Cortical graft harvested from the ribs for frontal bone reconstruction
Bicoronal flap raised and costal grafts were fixed with the frontal process with mini bone screws and stabilised
Bone graft was covered with miracle protein rhBMP-2 to induce new bone formation
DCR was performed by creating new communication between nasolacrimal sac and nasal mucosa with silicone tube
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