Category: Jaw Deformity

Successful correction of disproportionately long lower jaw without any scars

27/6/2016

A 26 year old man reported to our hospital seeking to correct his long 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 ramus region, excess bone was removed and the segment 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 lower jaw bone correction done without any scars on the face. His profile also improved dramatically giving him a renewed confidence.

Preoperative facial view showing long face with disproportionately large lower jaw

Profile view showing disproportionately long lower jaw giving asymmetric appearance

Intraoral view showing reverse bite

Complete reverse bite with midline shift

Intraoperative view - Sagittal split on right side

Intraoperative view - Sagittal split on left side

Mandibular nerve traced from foramen ovale and saved

Excess bone removed from buccal cortex to setback the mandible

Excess bone separated from mandible to correct the length

Bone plates fixed to stabilize the segments after achieving proper occlusion

Proper occlusion achieved and segemnts stabilized with bone plates

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Successful removal of huge infected odontogenic keratocyst and reconstruction of lower jaw without any scars

9/7/2015

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A 32 year old man from Trichy came to our hospital for expert treatment for his lower jaw defect. He complained of an intermittent pain and swelling in the right side of his lower jaw. The swelling was initially small and gradually increased to its present size for a period of 3 months.
Maxillofacial Surgeon Dr. S.M. Balaji performed the clinical and radiological investigations. OPG and 3D CT scan showed a large radiolucent lesion involving impacted third molar. Almost entire bone in this portion of the lower jaw was lost. A biopsy of the lesion proved to be keratocyst due to impacted third molar.
Dr. Balaji successfully enucleated the cyst removing the cyst lining completely along with the affected teeth. Inferior border of the mandible and condyle preserved for continuity, graft contoured in L shape with titanium screws and inserted into the surgical site. Graft near the body of the mandible fixed with titanium plates & the surgical site was closed.

Preoperative digital orthopantomogram showing huge radiolucent lesion involving the entire ramus of the mandible on the right side

Costochondral rib graft harvested to reconstruct the affected portion of mandible

After complete removal of the cyst harvested rib graft used to reconstruct the defective portion of mandible

Immediately after suturing

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Successful resection of Aneurysmal bone cyst followed by jaw reconstruction

1/7/2015

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A 28-year-old female reported to our hospital with a painful, bony swelling lesion in the front teeth region of her lower jaw. She had undergone a biopsy of the lesion elsewhere which proved to be aneurismal bone cyst. A 3D CT scan revealed the exact size and extent of the lesion in the anterior mandibular region. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed a complete resection and reconstruction. A radical excision of the lesion was done with complete resection of all tissues lining the cyst and any of its components from the surrounding soft tissues. The involved teeth were also extracted. To reconstruct the residual defect, a graft from iliac crest was harvested using trapdoor technique. The harvested graft was used to reconstruct the residual mandibular defect. The surgical site was sutured. The patient was happy that the lesion was excised and jaw bone was reconstructed successfully.

3D CT scan image showing extent of the aneurysmal bone cyst in mandibular anterior region

Complete excision of cyst lining, affected tissues and removal of involved teeth

Bone grafted from iliac crest using trap door technique

Harvested graft used to reconstruct the residual bone defect

Surgical site closed

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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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Miracle protein rhBMP-2, bone graft and implants placed to replace missing teeth in deficient jaw bone

30/9/2014

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A 45-year-old man from Australia came to our hospital seeking fixed replacement of his multiple missing teeth. The loss of many teeth over a long time led to progressive shrinkage of the jaw bone. The height of bone in the lower jaw was inadequate to place implants. Doctors elsewhere advised only removable dentures but the patient wanted fixed teeth to be able to chew and speak comfortably without the fear of dentures slipping off.

Maxillofacial Surgeon & Implantologist Dr. S.M. Balaji successfully reconstructed the deficient jaw using rhBMP-2 and bone graft to enable placement of implants and fixed teeth. The broken upper front teeth were extracted and immediate implants were placed in the same sockets without any bone loss. Implants were also placed in the right upper jaw. Implants and rhBMP-2 protein were placed in the lower jaw. This miracle protein stimulates the body’s own cells to form new bone thereby augmenting the jaw.

A costochondral rib graft was harvested & used to reconstruct the deficient height of the lower jaw and implants were placed. Subsequently, ceramic crowns closely resembling natural teeth will be fixed to the implants to complete the rehabilitation. The patient was very happy that he will have fixed teeth that will help him chew foods easily & give him a beautiful smile.