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Successful removal and reconstruction of huge osteolytic cystic lesion of lower jaw without any scars

14/3/2017

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​30 year old women reported to our hospital with the complaints of swelling in right side lower half of the face. She also said that this swelling was there for a very long period with occasional numbness in the right side of the face.
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 obtained 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 the entire lesion and reconstruction of the affected portion of mandible in the same surgery.
Preoperative 3DCT scan view showing erosion of the cortical bone with expansion of the body and ramus of mandible
Preoperative 3DCT scan view showing erosion of the cortical bone with expansion of the body and ramus of mandible - lingual side
Preoperative 3DCT coronal slice view showing impacted wisdom tooth with huge osteolytic lesion of left ramus of mandible
Preoperative digital orthopantomogram showing large osteolytic lesion involving entire right half of the mandible
Harvested costochondral graft used to reconstruct the mandible
Affected portion of jaw showing complete osteolysis with wide spread was removed in toto
Harvested costochondral graft used to reconstruct the huge defect
Immediately after suturing
Postoperative digital orthopantomogram showing complete reconstruction of the right side of mandible
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Successful removal and reconstruction of cystic lesion in lower jaw 

20/8/2016

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​A 28 year-old man came to our hospital with a complaint of pain in his lower jaw. A digital X-ray and 3DCT scan was taken revealed a large cystic lesion extending from canine to canine of the mandible with complete erosion of the labial plate.
 Maxillofacial surgeon Dr. S.M. Balaji expertly removed the entire cystic lesion along with the lining with affected teeth in toto. Reconstruction of the bone defect was done using bone graft obtained from the retromolar region.  Following surgery the wound healed well and the patient was happy to be cured of his ailment.
Preoperative digital orthopantomogram showing osteolytic cystic lesion involving lower anterior region of mandible
3DCT view showing buccal cortex erosion in lower anterior region of mandible
Intraoperative view showing surgical exposure of cystic lesion
Cystic lesion removed along with the lining and prepared for HPE
Bone defect after removal of the cystic lesion
Bone graft obtained from the impacted teeth region
Removed of affected mandibular anterior teeth and impacted third molars
Bone graft fixed into the defective region of mandible
Immediately after suturing
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Complete removal of huge infected cyst involving entire anterior maxilla followed by reconstruction

26/6/2016

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A 26 year-old boy form West Bengal came to our hospital with a complaint of swelling with occasional pain in his upper jaw. A digital X-ray took revealed a large cystic lesion extending anterior teeth to premolar of the maxilla with complete erosion of the labial plate.
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Histopathological examination of the specimen showed it to be a huge infected dental cyst due to continuous trauma from occlusion resulting from anterior deep bite. Maxillofacial surgeon Dr. S. M. Balaji successfully removed the entire cystic lesion along with the lining in toto. Followed by defective region of the upper jaw was reconstructed using costochondral rib graft. Following surgery the wound healed well and the patient was happy to be cured of his ailment. After complete bone formation, fixed dental replacement of the missing teeth will be done using dental implants. 
Preoperative digital orthopantomogram showing huge osteolytic lesion in anterior region of maxilla
Preoperative 3DCT view showing huge osteolytic lesion involving entire anterior and extending to the molar region of upper jaw
Axial view showing expansile osteolytic lesion involving entire left side of maxilla
Sagittal view showing buccopalatal expansion of cyst with bodily displacement of involving teeth
Costochondral graft obtained from 7th rib to reconstruct the defective portion of upper jaw
After raising gingivomucoperiosteal flap elevated and cystic lesion exposed
Removal of infected cyst in toto
After removal of cyst bone cavity debrided and diathermy applied
Costochondral graft used to augment the defective portion of upper jaw
Immediately after suturing
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Successful removal of huge dentigerous cyst involving entire left side of lower jaw without any scars

2/6/2016

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​A 25-year-old woman reported to our hospital with a complaint of swelling with pain in her left side of lower jaw. A digital X-ray took revealed a large cystic lesion extending entire ramus and angle and part of the body of the mandible involving the molar teeth.
Histopathological examination of the specimen showed it to be a chronic infected dentigerous cyst. Maxillofacial surgeon Dr. S.M. Balaji expertly removed the entire cystic lesion along with the lining with affected teeth in toto. Following surgery the wound healed well and fixed molar teeth given using dental implants in the newly formed bone with good retention, patient was happy to be cured of her ailment and to have fixed teeth.
Preoperative intraoral view
Preoperative digital orthopantomogram showing huge osteolytic lesion involving left side of mandible
Intraoperative view showing complete distruction of the bone due to cystic lesion
Removal of cyst lesion along with the involved tooth in toto
Postoperative digital orthopantomogram showing complete removal of cyst and new bone formation
Dental implants fixed in the newly formed bone with good retention
Digital orthopantomogram showing implants fixed in newly formed bone
Cosmetically well blended fixed ceramic prosthesis loaded on to the dental implants
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Successful removal of huge dentigerous cyst in lower jaw along with the impacted canine tooth

28/4/2016

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A 23 year-old boy came to our hospital with a complaint of swelling with pain in his lower jaw. A digital X-ray took revealed a large cystic lesion extending from anterior teeth to premolar of the mandible with complete erosion of the labial plate and impacted canine tooth.
 Histopathological examination of the specimen showed it to be a dentigerous cyst. Maxillofacial surgeon Dr. S.M. Balaji expertly removed the entire cystic lesion along with the lining with affected teeth in toto. Following surgery the wound healed well and the patient was happy to be cured of his ailment.
Huge osteolytic lesion involving the lower anterior region of jaw with impacted canine tooth
Costochondral rib graft obtained to correct the defective portion of the lower jaw
Dr. S. M. Balaji operating on the patient
Intraoperative view showing complete removal of cyst along with the impacted canine tooth
Defective portion of the lower jaw was reconstructed using costochondral rib graft
Immediately after suturing
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Successful removal of huge recurrent infected follicular cyst and reconstruction of lower jaw without any scars

15/2/2016

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A 28 year old man from Nigeria came to our hospital for expert treatment for his lower jaw defect. He gave the history of surgical removal of cystic lesion which was histopathologically diagnosed as follicular cyst in his lower jaw twice in his hometown and reconstructed with Bio-oss synthetic bone protein. Recurrence of the cystic lesion noted and the swelling was initially small and gradually increased to its present size for a period of 5 months. He was worried for the recurrence and wants to have permanent solution for the same.
Maxillofacial Surgeon Dr. S.M. Balaji performed the clinical and radiological investigations. OPG and 3D CT scan showed a large radiolucent lesion extending from the lower left first molar teeth till right first premolar region. Almost entire bone in this portion of the lower jaw was lost.
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Dr. Balaji successfully removed the cyst completely along with the affected teeth and bone. Rib graft was harvested and the used to reconstruct the jaw bone defect & the surgical site was closed. After subsequent healing, implants & ceramic crowns will be placed for fixed replacement of lost teeth.
Facial view showing swelling in the lower half of the face on the left side
Preoperative intraoral view showing huge swelling with cortical expansion and dislodged teeth in the affected region of mandible
3DCT scan view showing complete erosion of the buccal cortex and adjacent teeth root resorption due to cystic lesion
Preoperative digital orthopantomogram showing huge radiolucent lesion involving the symphysis and parasymphysis region of the mandible on the left side
Costochondral rib graft harvested to reconstruct the affected portion of mandible
Intraoperative view showing removal of the cyst along with the affected bone
Cystic lesion with affected teeth and bone removed in toto
Harvested rib graft used to reconstruct the defective portion of mandible
Immediately after suturing
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Successful jaw reconstruction for Bangladeshi man suffering from extensive jaw cyst

9/2/2016

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A 30-year-old man from Bangladesh was suffering from severe pain and swelling in his right side of lower jaw. He also complained of difficulty to open his mouth wide and bite and chew foods. He was advised by his family doctor in his home town to go to Balaji Dental and Craniofacial Hospital at Chennai, India, for specialized treatment.
Maxillofacial Surgeon Dr. S.M. Balaji thoroughly evaluated his jaw defect clinically and using advanced 3D CT scan. The scan images showed that he had multiple and extensive areas of bone loss that appeared to resemble large cystic tumors involving the almost entire right side of lower jaw.
Biopsy of the lesion was done which proved it to be odontogenic keratocysts. Dr. Balaji planned a complete reconstruction of the lower jaw right side, using the man’s own rib graft. The affected portion of the lower jaw bone was surgically removed. Diseased portions of the bone were completely and thoroughly removed to ensure that there is no recurrence. A costochondral cartilage graft (rib graft) was taken and used to reconstruct the lower law. Following a few months time, rehabilitation will be completed with implants and ceramic prosthesis. The man feels very happy for the surgery outcome and the entire surgery was done intraorally avoiding external scar formation.   
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Successful jaw reconstruction for young boy suffering from extensive jaw cyst

14/10/2015

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A 14-year-old boy from Bangladesh was suffering from severe pain in his lower teeth and lower jaw. He also complained of difficulty to bite and chew foods. His parents, both doctors, were advised by their family doctor in their home town to go to Balaji Dental and Craniofacial Hospital at Chennai, India, for specialized treatment for their son.
Maxillofacial Surgeon Dr. S.M. Balaji thoroughly evaluated his jaw defect clinically and using advanced 3D CT scan. The scan images showed that he had multiple and extensive areas of bone loss that appeared to resemble large cystic tumors involving the almost entire lower jaw. Few teeth were missing and there were several supernumerary teeth embedded inside the jaw bone.
Biopsy of the lesion was done which proved it to be odontogenic keratocysts. Dr. Balaji planned a complete lower jaw reconstruction using the boy’s own rib graft. The affected portions of the lower jaw bone on both sides were surgically removed. Diseased portions of the bone were completely and thoroughly removed to ensure that there is no recurrence. A costochondral cartilage graft (rib graft) was taken and used to reconstruct the entire lower law. Following a few months time, rehabilitation will be completed with implants and ceramic prosthesis.
The boy and his parents are very happy with the surgery outcome.  The Hon’ble Former Chief Justice of Madras High Court and Judge Supreme Court of India His Excellency H L Gokhale and his wife visited the hospital and greeted the boy and his parents. Chief Justice expressed his wishes and fed the boy a piece of cake. He also commended Dr. Balaji on his remarkable expertise and applauded his excellence and outstanding achievements in successfully performing many such complex and rare reconstructive surgeries.
Preoperative 3DCT scan view showing cystic lesion involving the left ramus and angle of mandible
Cystic lesion with cortical erosion seen in the right side of the lower jaw
X-ray showing multiple cystic tumors of jaws
Graft harvested from rib
Tumor portion of right lower jaw excised
Excised portion of left lower jaw
Left lower jaw affected with cystic tumor surgically removed
Excised portion of right lower jaw
Rib graft used to reconstruct resected portion of jaw
Complete lower jaw reconstruction using the grafts
Immediately after lower jaw reconstruction surgery
Postoperative digital orthopantomogram showing complete removal and reconstructed using costochondral rib graft with good bone formation
The Hon'ble Former Chief Justice of Madras High Court and Judge Supreme Court of India His Excellency H L Gokhale wished the boy
His Excellency fed the boy a piece of cake and wished him
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