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Combined long lower jaw and deviated chin correction for enhanced appearance

10/5/2016

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​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.
Preoperative profile view showing disproportionately long lower jaw
Preoperative 3DCT scan showing long lower jaw and reverse bite
Preoperative introral view showing reverse bite
Intraoperative view showing corrected lower jaw bone and bite
Postoperative profile view showing corrected lower jaw alignment without any visible scars on the face
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Successful treatment of lower jaw fractures sustained in a road traffic accident

4/7/2015

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A young man had met with a motor vehicular accident a few days in which he had sustained injuries to his lower jaw. He had severe jaw pain, his teeth occlusion was completely deranged and he had great difficulty in biting, chewing, swallowing and speaking.
A preoperative 3D CT scan revealed fracture in the right mandibular parasymphysis region and left angle of mandible. Maxillofacial Surgeon Dr. S.M. Balaji successfully fixed and stabilized the fractured segments using bone plates and screws. Accurate occlusion and bite was achieved.
Fractured lower jaw with displacement of the fractured segment leading to inability to bite
Digital orthopantomogram showing left angle and right parasymphysis fracture
3DCT scan view showing fracture involving left angle and right parasymphyseal fracture
Intraoperative view showing fracture stabilization with 4 hole titanium bone plate
Proper bite achieved and right parasymphyseal fracture stabilized with 4 hole bone plate
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Combined lower jaw and chin correction for enhanced appearance

16/5/2015

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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.
Preoperative profile view showing long lower jaw giving asymmetric profile
Preoperative 3DCT scan showing long lower jaw and reverse bite
Intraoperative view showing corrected occlusion by following bilateral sagittal split osteotomy with reduction genioplasty
Corrected facial profile following surgery without any scars on the face
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Successful removal and reconstruction of huge cystic lesion of lower jaw enhancing the functional stability

23/12/2014

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A 20 year old boy reported to our hospital with the complaints of swelling in right side lower half of the face. He also said that this swelling was there for a very long period with occasional numbness in the right side.

After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as odontogenic keratocyst (OKC) involving right body and ramus of the mandible. He planned to remove the entire lytic lesion and reconstruction of the affected portion of the mandible in the same surgery. Costochondral graft was harvested from the ribs to reconstruct the mandible. Through intraoral approach, after raising gingivomucoperiosteal flap extending distally, the entire lesion along with the affected portion of mandible was removed in toto. Harvested rib graft was used to reconstruct the defective region of mandible. Patient is very happy to have both removal of lesion and reconstruction of the affected portion of mandible in the same surgery. 
Preoperative digital orthopantomogram showing large osteolytic lesion involving entire right half of the mandible
Preoperative 3DCT scan view showing erosion of the cortical bone with expansion of the body and ramus of mandible
Harvested costochondral graft used to reconstruct the mandible
Affected portion of the mandible with sufficient marginal clearance was cut and removed intraorally
Affected portion of jaw showing complete osteolysis with wide spread was removed in toto
Harvested costochondral graft used to reconstruct the huge defect
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Combined lower jaw and chin correction for enhanced appearance

27/11/2014

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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.
Crooked chin giving face an asymmetric appearance
Incorrect bite due to protruding lower jaw and deviated chin bone
Combined bilateral Obwegeser sagittal split osteotomy (lower jaw correction) and genioplasty (chin correction)
Asymmetry and deviated chin corrected improving appearance immediately after surgery without any scars
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Combined jaw correction & lip and nose defect correction with Abbe flap technique & rehabilitation with implants for bilateral cleft lip & palate

10/11/2014

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A 19-year-old boy reported to our hospital seeking to correct his nose, lip and jaw defect and to replace his missing upper front teeth. He was previously operated for bilateral cleft lip and palate elsewhere where his entire premaxilla was removed. His upper lip was very thin in the middle, his lower jaw was severely protruding and his nose defect affected his facial profile giving an unpleasant appearance. Also because of his missing upper front teeth he was unable to bite and eat properly. 

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed a combined jaw, lip and nose correction. An Obwegeser’s bilateral sagittal split osteotomy was done reshaping the lower jaw bone and bringing it into proper alignment with the upper jaw. Dental implants were placed in the upper jaw to replace the missing teeth. In the Abbe flap technique, a flap of tissue was taken from the lower lip, rotated across the mouth and sutured together with the thin upper lip with the base of the flap still attached to the lower lip to maintain blood supply. The flap was taken with hair follicles to ensure proper moustache growth. After 3 weeks the flap was divided giving the upper lip a normal form and function. Ceramic crowns were fixed to the implants. Following complete rehabilitation, his appearance and self-confidence improved greatly and he is very happy with the results.

Preoperative facial view showing defective cleft lip and nose due to bilateral cleft defect
Preoperative intraoral view showing incorrect bite due to removal of premaxilla leading to missing teeth in upper front region of jaw
Reconstructed columella and shape of the ala of the nose by Abbe flap technique
Immediate postoperative view showing corrected bite by following Obwegeser's bilateral sagittal split osteotomy in mandible and lip revision by Abbe flap
Postoperative image showing corrected bite and missing teeth replacement with dental implant prosthesis
Postoperative facial view showing corrected lips, nose and missing teeth replacement giving enhanced appearance
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Ameloblastoma of lower jaw excised using intraoral approach

30/9/2014

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A 28 year old man from Cochin reported to our hospital with the complaints of swelling with pain in right side of his lower jaw for past 2 months. Radiologic examination showed a radiolucent lesion extending posteriorly from the mandibular right second molar involving the ramus. Histopathological investigations showed the lesion to be ameloblastoma.

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed an intraoral excision of the infected portion of the jaw with a marginal mandibulectomy procedure. The surgical procedure done through the mouth avoided any scarring of the face. Following surgery, the patient recuperated well and was happy to have his ailment treated successfully. 

Preoperative view showing swelling in right lower half of the face
Preoperative digital orthopantogram showing huge unilocular radiolucency extending till coronoid process on right side
Affected portion of the lower jaw was surgically removed with intraoral approach along with the involved tooth
The intraorally excised ameloblastoma with the instruments used
Immediately after removal of the lesion mucosal flap was sutured
Postoperative orthopantomograph following successful marginal mandibulectomy of the lesion
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Simultaneous nose & jaw correction and lip correction with Abbe flap in cleft child from Seychelles

23/9/2014

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A 13-year-old boy from Seychelles, born with bilateral cleft lip and palate was brought to our hospital by his parents for expert cleft treatment. He was operated elsewhere for primary cleft lip and palate. He had a thin upper lip, broad flattened nose and protruding lower jaw for which he sought treatment.

Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, the flap will be divided giving the upper lip a more natural, improved form.

Simultaneously, the broad nose and protruding lower jaw was reshaped to make them more proportionate and balanced. Protruding lower jaw was corrected by following bilateral sagittal split osteotomy (Obwegeser’s osteotomy) and excess bone obtained was used to augment the dorsum of the nose. Following surgery, the nose appeared sharp & defined with more proportionate jaw profile. 

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Corrective surgery for protruding upper jaw

19/8/2014

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A 32-year-old man reported to our hospital seeking to correct his protruding upper jaw to enhance his appearance. His forwardly placed upper jaw and upper teeth made it difficult to close the mouth normally and he was very self-conscious of his looks.

Radiographic analysis of the facial bones showed that his maxilla (upper jaw) was disproportionately large compared to the lower jaw which caused the upper jaw and teeth to be very protruding. Maxillofacial surgeon Dr. S.M. Balaji performed the corrective jaw surgery or orthognathic surgery. The excess bone from the upper jaw was removed & the jaw was set back in proper alignment with the lower jaw. Immediately following surgery his appearance improved with the more balanced features. The procedure was done from within the mouth so there were no scars. The man was very happy with his new, improved look. 
Severely protruding upper jaw causing inability to close the mouth normally and unpleasant appearance
Very forwardly placed upper teeth due to large upper jaw
Upper jaw sculpted and set back improving appearance without any scars
More balanced alignment of upper with lower teeth following orthognathic surgery
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Combined corrective jaw surgery & sinus-lift with implant placement

16/8/2014

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A 30 year old lady from Saudi Arabia reported to our hospital with the complaints of missing teeth and more forwardly placed upper front teeth. She wanted to correct both the proclination and to replace the missing teeth with the dental implants in the same visit. She consulted various dental implantologists regarding her missing teeth replacement where they refused fixed replacements due to lack of bone support. 

Maxillofacial Surgeon and Implantologist Dr. S. M. Balaji successfully corrected both the proclination and replacement of her missing teeth in the same surgery. By following Le Fort I osteotomy the severely protruding upper jaw was set back to a more balanced occlusion. A sinus-lift procedure was done to enable implant placement in the decreased height region of the upper jaw. A “window” was cut & the lining of the maxillary sinus was lifted. The excess bone from the jaw correction was ingeniously packed in the space below the sinus membrane thereby increasing the width of jaw bone & implant was successfully placed. Later ceramic crowns will be fixed for complete dental rehabilitation. 
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Corrective jaw surgery (orthognathic surgery) for gummy smile

25/7/2014

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An 18-year-old girl from Bangalore was brought to our hospital by her parents for expert correction of her protruding upper jaw that caused an unattractive “gummy smile”. The girl was about to begin her college education and she was very self-conscious about her appearance.

Her facial bones were analyzed using digital x-rays. Her upper jaw or Maxilla was disproportionately larger as compared to the lower jaw and her upper lip was short causing too much of the gums to be visible while smiling. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the corrective jaw surgery or orthognathic surgery with Le Fort I osteotomy. The upper jaw was set back, reshaped & realigned in perfect facial harmony. The entire procedure was done from inside the mouth so there were no scars. Immediately following surgery the girl’s appearance was greatly enhanced and her more attractive, pleasing smile boosted her confidence.
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Simultaneous correction of unilateral cleft nose and  prognathic lower jaw

17/6/2014

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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. 
Preoperative view showing depressed right alar base due to huge cleft defect
Preoperative intraoral view showing reverse bite due to restricted growth of upper jaw
Costochondral graft harvested to correct the nose defect
Depressed ala of the nose was shaped with the harvested chondral graft
Through intraoral approach alar base was raised with the graft and cleft defect was corrected
Postoperative view showing corrected alar base and ala of the nose
Postoperative occlusal view showing enhanced bite with proper overjet and overbite
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Successful jaw reconstruction with rhBMP-2 & complete rehabilitation with implants

12/6/2014

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A 30 year old man from Oman came to our hospital with the complaints of severe pain and swelling in the right side of his lower jaw. A 3D CT scan & thorough histopathological examination revealed he had multilocular ameloblastoma in the right lower jaw.

Maxillofacial surgeon Dr. S.M. Balaji expertly planned the complete jaw reconstruction. The affected portion of the mandible (lower jaw) was surgically ressected. A rib graft was harvested & used to reconstruct the excised portion. Miracle protein rhBMP-2 was placed. This stimulates the body’s own cells to form new bone at the site thereby ensuring complete healing of the bone defect.

Few months following surgery, remarkable healing of the jaw bone defect was seen. Implants were placed in the missing teeth region of the lower jaw and ceramic prosthesis were fixed. The man was very happy that his jaw bone defect is cured completely and with the implants he is able to chew & eat well. 
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Successful correction of protruding lower jaw without any scars

27/5/2014

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A 25 year old man reported to our hospital seeking to correct his protruding lower jaw. This gave him an aged appearance and he was not happy with his facial profile.

Maxillofacial Surgeon Dr. S. M. Balaji expertly planned to correct his lower jaw protrusion by using bilateral sagittal split osteotomy technique (Obwegeser sagittal Split osteotomy). Intraorally a cut was made bilaterally in the lower jaw bone in the mandibular ramus region and the bone was set back to its correct position and thus correct dental occlusion was achieved. Results are immediate and the patient was happy to have his jaw bone correction done without any scars on the face. His profile also improved dramatically giving him a renewed confidence.
Pre operative profile view showing severely protruded lower jaw
Pre operative intra oral view showing reverse bite - negative overjet
During procedure - sagittal split osteotomy on the right side of lower jaw
During procedure - sagittal split osteotomy on the left side of lower jaw
Post operative profile view showing enhanced appearance without any scars
Post operative intra oral view showing corrected bite with excellent overjet achieved
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Combined rhinoplasty and lower jaw correction without scars

8/5/2014

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Cleft nose defect affecting facial profile
Nose defect and protruding lower jaw causing an unpleasant appearance
Costochondral graft harvested to reconstruct the nose
Immediately after rhinoplasty- nose reconstructed without scars
Nose defect corrected & protruding lower jaw set back with corrective jaw surgery without scars
A 26-year-old girl reported to our hospital seeking expert correction of her cleft nose and jaw defect to enhance her facial profile. She was operated elsewhere in her childhood for cleft lip and cleft palate. Now her nose appeared collapsed on the left side and her protruding lower jaw deflected from a pleasing profile. 

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed a combined nose & jaw correction. A costochondral graft was harvested and used to reconstruct the collapsed portion of the nose. The procedure was done from inside the nose itself so that there are no scars. Mandibular shortening was done to make the lower jaw proportionate and to improve the facial profile. Immediately following surgery, her facial profile and appearance greatly improved and she was very happy to have a more attractive appearance without any scarring on the face. 
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Bone deficient region of upper jaw reinforced with bone graft & implants placed

27/3/2014

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A 29-year-old man from Singapore reported to our hospital seeking expert treatment for his widely spaced upper right teeth due to which there was food impaction problem & caused an aesthetic concern. Also his upper right teeth were mobile which made it very difficult to bite & chew food. 

Digital X-ray taken showed bone loss in the region of upper right incisor, canine & first premolar that caused mobility of the teeth. Maxillofacial Surgeon Dr. S.M. Balaji performed the jaw bone reconstruction. The periodontally weakened teeth were extracted and implants placed. A symphysis bone graft was harvested from the lower jaw chin region & placed in the bone deficient region of the upper jaw to compensate the bone deficiency. The surgical site was sutured. Crown prosthesis will be given later to completely replace his missing teeth. 
Pre operative intra oral view showing spacing between the teeth due to week periodontal attachments
Pre operative digital radiograph showing severe supporting bone loss due to periodontal infection
During procedure - Periosteal flap raised showing severe bone loss
Upper anterior teeth with severe mobility was extracted
Extraction socket showing severe bone loss
Bone grafting done from the symphyseal region to enhance the bone support for implants
Implant fixed and harvested bone was placed to close the severe bone defect
Periosteal flap was sutured
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Excellent profile enhancement by simultaneous upper & lower jaw correction

26/3/2014

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A 20 year old girl reported to our hospital wanting to correct her gummy smile. Also her protruding lower jaw affected her appearance. She had low self-esteem & she wanted to enhance her looks. She had already consulted many dentists and had braces for 3 years elsewhere, but she was not satisfied with the results. Her parents too were anxious to correct her smile and enhance her facial appearance before getting her married.

Maxillofacial Surgeon Dr. S. M. Balaji expertly planned for simultaneous correction of her both upper and lower jaw. Surgical correction of gummy smile was done with Le Fort I osteotomy to reduce the maxillary excess bone. Protruding lower jaw was set back intra orally with sagittal split osteotomy. Post operatively her appearance improved greatly & instantly due to excellent profile correction. She & her parents were very happy with the immediate results & that the jaw correction surgery was done without any scars on the face. 
Pre operative frontal view showing increased exposure of teeth and incompetant lips
Lateral view showing - gummy smile with protruding lower jaw
Pre operative intra oral view showing crossbite in left side with increased vertical height of upper jaw
Post operative frontal view showing competent lips with enhanced appearance
Post operative profile view showing proportionately aligned upper and lower jaw
Post operative intra oral view showing proper bite with good overjet and overbite
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Failed bone graft for lower jaw treated elsewhere reconstructed successfully with rhBMP-2 

26/3/2014

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An 18 year old boy reported to our hospital with the complaints of severe pain and swelling in the left side of his face. Intraorally, a bone plate was exposed and huge infection with pus discharge adjacent to the exposed plate region was noticed.  He gave a history of odontogenic keratocyst (OKC) in the left side of the lower jaw which was removed elsewhere and reconstructed with bone graft and bone plate twice, 1 year back. His parents were frustrated due to repeated surgeries.

Maxillofacial Surgeon Dr. S. M. Balaji adroitly planned to remove the infected bone graft and plate and to reconstruct the lower jaw in a single surgery. He approached the surgical site extraorally through the previous scar region and removed the dislodged bone plate and sequestrum completely. Adjacent infected bone was removed with bone curette and a new NiTi bone plate was fixed to the adjacent healthy bone. To enhance the rigidity, costal graft was harvested and placed near to the bone plate with rhBMP-2 to increase the efficiency of new bone formation. Mucosal flaps were approximated in layers with very minimal scar formation. 

Post operative X-ray taken after 3 months revealed good amount of healthy bone formation maintaining the contour of the mandible using bone plate.
Pre op X ray showing failed bone grafting done elsewhere and displaced bone plate with infection
Extraoral approach through the previously operated scar region and infected bone plate removed
New NiTi bone plate fixed and stabilised well to the healthy adjacent bone
Costal graft (rib graft) harvested from his thorax region
Harvested graft fixed near the bone plate to enhance new bone formation and maintain the rigidity
Miracle protein rhBMP-2 placed to increase the efficiency of new bone formation
Mucosal flaps sutured in layers and good approximation leaving very minimal scar
Post op X ray showing good amount of healthy bone formation and maintaining the contour of the mandible with bone plate
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Successful union of cleft bone into a single jaw bone using miracle protein rhBMP-2

19/3/2014

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An 8 year old boy with bilateral cleft lip and palate defect from Mumbai was brought to our hospital with his parents for closure of the cleft defect in the teeth bearing region of upper jaw bone and further rehabilitation of his cleft deformity. The primary cleft lip and palate repair was done elsewhere.

The premaxilla was separated from rest of the alveolus which can be clearly appreciated in 3D CBCT scan. Thus upper alveolus was separated into three different parts which will severely affect the development of teeth later.

Maxillofacial Surgeon Dr. S. M. Balaji performed the premaxillary setback procedure with rhBMP-2 which helps in uniting the three parts into a single jaw bone with new bone formation. This surgery helped for proper growth and development as well as alignment of his teeth.
Pre operative intraoral view showing protruding premaxilla
3D CBCT scan showing detached and forwardly placed premaxilla from rest of the alveolus
Intra oral view showing severe anterior deep bite due to lowered position of premaxilla and palatally placed lateral incisors due to lack of bone
During surgery rhBMP-2 placed in the cleft defect region
Immediate post operative view showing accurate approximation of premaxilla
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Complete rehabilitation for cleft child from 3 months to 16 years of age Successive surgeries with 16 years follow-up

18/3/2014

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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.  
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Lower jaw fracture successfully treated after previous failed procedures done elsewhere

6/3/2014

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CT scan showing non-healing results of previous surgeries done elsewhere for right side lower jaw fracture
Fracture site exposed showing non-union of segments
Fracture fixed with bone plates and screws
Cortico-cancellous bone graft harvested from right hip region
Bone graft packed into the fracture defect
Bone ends covered with collagen sponge soaked in rhBMP-2
rhBMP-2 will stimulate new bone formation at the bone ends ensuring complete healing
Immediately after surgery- Wound site sutured
A 35-year-old man reported to our hospital seeking expert treatment for his lower jaw (mandible) fracture. He gave a history of having sustained the injury in a road traffic accident. He had sought various treatments elsewhere but the multiple surgeries were futile with non-healing results. 

A CT scan showed complete non-union of the fractured segments. Maxillofacial Surgeon Prof. S.M. Balaji performed the surgery for jaw fracture fixation. The fracture site was accessed and fibrous tissue as a result of non-healing of the fractured fragments was removed. The bone ends were freshened, proper occlusion was established, and the fractured fragments of the lower jaw were fixed with a 6-hole & 4-hole bone plate with 2 mm screws. A cortico-cancellous bone graft from the right hip region was harvested and packed into the fracture defect. The graft and bone ends were covered with a collagen sponge soaked in rhBMP-2. rhBMP-2 is a miracle protein that stimulates the body’s own cells to form new bone thereby ensuring complete healing of the bone defect. Following this, the wound was sutured.

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