A 22 year old girl reported to our hospital for the surgical correction of asymmetry over the left side of the face. Facial asymmetry may be present in cases of hemifacial microsomia, TMJ ankylosis or may have resulted following condylar fractures. This patient had a mandibular deficiency at the ramus level and deficiency measured almost 14 mm with a resultant occlusal cant.
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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. Paragingival incision was placed over the left 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. Patient feels very happy to have the facial asymmetry correction without any scars on the face.

​A 19-year-old boy came to our hospital seeking to correct his facial asymmetry that gave unpleasant appearance. The boy was very anxious & wanted a cosmetic correction to enhance his appearance without any scars.
Maxillofacial Surgeon Dr. S.M. Balaji diagnosed that the asymmetrical face was due to unilateral masseter hypertrophy. Masseter muscle is mainly responsible for the movements of the lower jaw & plays an important role in facial aesthetics. When the muscle becomes enlarged or thickened, it gives the lower third of the face a wide, square-shaped appearance.
Maxillofacial Surgeon Dr. S. M. Balaji surgically reduced the bulk of the enlarged Masseter muscle from within the mouth itself so there were no scars. Along with the muscle, the buccal surface of the gonial angle of the mandible was also trimmed. Immediately after surgery the lower jaw appeared more proportionate and his appearance greatly improved. The boy and his family were very happy to have a more attractive, natural look.

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 20 year old girl reported to our hospital with a complaint of asymmetrical face giving her an unpleasant appearance and she was not able to chew foods due to slanting bite. Her parents were also worried & wanted the correction done without any scars on the face. The girl was too anxious due to her asymmetrical face which affected her self-esteem considerably.

After thorough clinical and radiological examination, it was diagnosed that she had hemifacial microsomia in which the ramul height of the mandible on right side was considerably less which led to asymmetry. Maxillofacial Surgeon    Dr. S. M. Balaji skillfully planned to correct her face as well as her bite with the innovative “Distraction Osteogenesis” technique. Intraorally Le Fort I osteotomy was done, lower jaw bone on the right side was cut and distractor device was fixed to the mandible at the ramus region. The screw attached to the distractor was turned gradually everyday that pushed the cut bone segments apart. New bone was formed in the resultant gap and the jaw bone was ultimately lengthened. After the face became symmetrical, the distractor was removed.

Thus entire surgery was done inside the mouth with no scars on the face.  The girl and her parents were very happy with the results.