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Successful jaw reconstruction for Bangladeshi man suffering from extensive jaw cyst

13/6/2017

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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.
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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. The man feels very happy for the surgery outcome and the entire surgery was done intra orally avoiding external scar formation.
4 months follow-up
4 months postoperative digital OPG and 3DCT shows good bone formation. Dental implants fixed in the newly formed bone with good stability and retention.
Preoperative facial view showing huge swelling in the right lower half of the face
Preoperative digital orthopantomogram showing huge radiolucent lesion with impacted tooth involving the entire body of the mandible on the right side
3DCT scan view showing huge osteolytic lesion with complete cortical bone destruction on the right body and ramus of the mandible
Costochondral rib graft harvested to reconstruct the affected portion of mandible
Infected portion of mandible removed with involved teeth - intraorally
Lingual surface of the excised bone showing complete removal of the affected jaw bone along with the huge cystic lesion
Harvested rib graft shaped to reconstruct the lower jaw defect
Harvested rib graft used to reconstruct the defective portion of mandible
Immediately after suturing
3 days postoperative digital orthopantomogram showing complete removal of affected bone and reconstruction using rib graft
Postoperative OPG following 4 months after reconstrution surgery showing enhanced bone formation
Postoperative 3DCT following 4 months showing enhanced new bone formation maintaining the contour of the mandible
Dental implants fixed into the newly formed bone with good stability and retention
Postoperative OPG showing implants fixed into the newly formed bone with good retention
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Multiple mandible surgeries done elsewhere failed, Complete reconstruction done successfully by Dr. S. M. Balaji

24/5/2017

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A 30 year old man from Bangladesh reported to us seeking reconstruction of left side of his lower jaw. Intraorally, a bone graft was exposed and huge infection with pus discharge adjacent to the exposed region was noticed.  He gave a history of dentigerous cyst in the left side of the lower jaw, the affected portion of the lower jaw along with the involved teeth were removed elsewhere and the jaw was reconstructed with fibular and iliac bone graft with bone plate thrice, 2 years back. He was frustrated due to repeated surgeries, that too which had subsequently failed.
​Difficulties faced – in patient’s words
  1. Not feeling proper bonding of the bone graft internally at the operated site. Sound of friction type when moving lower jaw
  2. Shift of lower jaw to the left during mouth-opening
  3. Left side of lower lip is numb
  4. Have been chewing food only on right side for last 8-9 years, cannot chew on the left side (sometimes feels pain in right side lower jaw)
  5. Concerned about the functionality of the upper left teeth & gums
​Maxillofacial Surgeon Dr. S. M. Balaji planned to remove the failed infected bone graft done elsewhere and to reconstruct the lower jaw in a single surgery. He approached the surgical site intraorally and removed the dislodged bone graft and sequestrum completely. Adjacent infected bone was removed with bone curette. A rib graft was taken and fixed to the lower jaw left side to reconstruct the defect. rhBMP-2 was placed to increase the efficiency of new bone formation. Mucosal flaps were approximated in layers. The patient is very happy to have entire surgery done in single stage without any scar on the face. The functionality of the lower jaw was also regained efficiently.
Preoperative 3DCT image showing failed mandibular reconstruction
Preoperative facial view showing depressed left side of face due to lack of bone
Preoperative view showing huge scar due to previous surgery and scarring due to extraoral sinus
Preoperative digital OPG showing failed bone graft
Rib graft obtained to reconstruct the mandible
After suturing
Rib graft adapted to the defective region of the mandible
Bone protein rhBMP2 placed to enhance the new bone formation
Immediately after suturing
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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 surgical removal and reconstruction of ameloblastoma of mandible

25/7/2016

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A 28 year old woman reported to our hospital with the complaint of swelling in the right side of her face. She added that there was pain in her lower jaw before later reduced and she had intraoral swelling.
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After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as ameloblastoma involving the right side body of the mandible. Surgery was planned to remove the lesion and reconstruct the affected jaw portion in a single stage. Through submandibular incision, complete removal of the lesion along with the involved tooth with sufficient clearance of the bone under General anesthesia.  Costochondral graft which was harvested was fixed to it. Incision was closed in layers. Patient was happy to have both removal and reconstruction in a single surgery.
Preoperative facial view
Preoperative digital orthopantomogram showing osteolytic multilocular lesion involving right body of mandible
3DCT view showing bony erosion in the buccal cortex of right body of mandible
Osteolytic lesion involving right side of mandible
Osteolytic lesion involving right side of mandible
Surgical exposure of the mandibular tumor
Removal of the affected portion of mandible along with the involved tooth with good clearance
Resected portion of mandible along with the involved tooth
After resection
Reconstruction using costochondral rib graft
Immediately after suturing
VIDEO: Video showing inferior mandibular nerve separated and saved
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Complete smile makeover following successful jaw reconstruction & dental implants for African boy

28/5/2016

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​A young African boy from Nigeria suffering from Ectodermal Dysplasia was referred to our Hospital for expert care. He had multiple missing teeth & had previously undergone bone grafting elsewhere but the graft had already resorbed & failed.
Maxillofacial Surgeon and Dental Implantologist Prof. Dr. S.M. Balaji performed the complete jaw bone reconstruction using costochondral rib graft . Implants were placed to replace his missing teeth. Following osseointegration of the implants, cosmetically well blended fixed ceramic prosthesis was given enhancing the appearance.
Multiple missing teeth in a boy suffering from Ectodermal Dysplasia
Xray before surgery
Failed bone graft done elsewhere
Harvested rib graft fixed to upper jaw bone
Lower jaw bone strengthened with rib graft
X-ray taken just after jaw reconstruction & implant surgery
Following ceramic prosthesis fixation giving enhanced natural smile
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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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Advanced transport Distraction osteogenesis technique for reconstruction of lower jaw after tumor removal

11/2/2016

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A 55 year old patient reported to our hospital with a large, bony swelling in the anterior portion of the lower jaw (mandible). He had said that the swelling had gradually increased in size over the past 1 year and there was spontaneous loss of few lower teeth over the last 6 months. He also reported of altered sensation in the lower lip for past 3 weeks which was his main concern.
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 A 3D CT scan was taken to gauge the extent of the lesion. A biopsy was done which showed the lesion to be a multiple cystic ameloblastoma (tumor) of the lower jaw. Maxillofacial Surgeon Dr. S. M. Balaji removed the entire bony tumor along with the involved bone and reconstructed the defective portion of mandible using the native bone itself without any bone graft by following advanced transport guided distraction osteogenesis technique.

The entire affected portion of the lower jaw was ressected with 1.5 cm marginal clearance followed by reconstruction using titanium plate guided bilateral tripod multi docking complex univector Herford plate guided mandibular transport distractor.

After 5 days of latency period, the distractors were activated at a rate of 0.5mm twice per day (on both sides) until the transport discs had reached the canine region on both sides (amount of distraction on the right side was 46mm and on the left 43.2mm). Following consolidation period of 3 months and radiological evidence of corticalization, the distractors were removed. And complete dental implant rehabilitation done for lower arch in the newly formed healthy bone. Cosmetically well blended fixed ceramic prosthesis given.
X-ray showing tumor in the lower jaw
3DCT scan view showing huge tumor involving more than half of the lower jaw
Intraoperative view showing removal of huge tumor mass intraorally
Complete removal of the tumor mass along with the involved bone in toto
Planning for the fixation of the transport distractor device to the mandible
After tumor removal, fixation of reconstruction plate and segments distracted 1 mm per day
During transport distraction
During distraction
After completion of distraction
After completion of the distraction - facial view
After removal of the distractors and fixing the fragments to the reconstruction plate to achieve the 'U' form of the lower jaw
Healthy new bone formation seen in postoperative 3DCT scan
Postoperative intraoral view showing enhanced healing and augmented new alveolar bone formation
Implants placed in the reconstructed lower jaw
Following dental implant rehabilitation cosmetically well blended fixed ceramic prosthesis placed
Comments

Extremely thin jaw bones reconstructed and rehabilitated with implants & prosthesis

10/2/2016

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A 25-year-old American came to our hospital seeking a fixed replacement for his missing teeth. He gave a history of having had multiple impacted teeth which were extracted before, elsewhere. Subsequently there was severe deficiency of bone in his upper & lower jaw due to which he was refused fixed teeth there.
A 3D CBCT scan taken revealed severely atrophied maxillary & mandibular bone. Maxillofacial Surgeon & Implantologist successfully performed the jaw bone reconstruction and dental implant replacement for his missing teeth in two stage procedure. Rib graft was harvested & used to reconstruct the thin upper & lower jaw bone.

After complete jaw reconstruction, dental implants were fixed in the reinforced regions of the maxilla & mandible. Following complete osseointegration of the implants with the surrounding bone, teeth prosthesis was fixed. The man is very happy to have fixed replacement of his missing teeth and to get back his confident, pleasing smile that remarkably improves his appearance.
Implants placed in the upper jaw following bone grafting
Implant fixed with good stability and retention into the reinforced bone
Implant fixed with good stability and retention
Implants in position with enhanced healing
After placement of implants in lower jaw showing good healing
After prosthesis fixed to implants in upper jaw
Ceramic prosthesis placed resembling natural teeth
Cosmetically well blended fixed ceramic prosthesis
Enhanced appearance following complete rehabilitation
Enhanced smile following implant prosthesis
Comments

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

9/2/2016

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An 18 year old girl from Bangladesh was brought to our hospital by her parents for expert treatment for her lower jaw defect. The girl complained of a intermittent pain and swelling in the left side of her lower jaw. The swelling was initially small and gradually increased to its present size for a period of 3 months. The parents were very worried about their daughter’s health.
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 premolar to second molar teeth involving impacted third molar. Almost entire bone in this portion of the lower jaw was lost. A biopsy of the lesion proved to be odontogenic keratocyst.
Dr. Balaji successfully removed the cyst completely along with the affected bone and teeth. 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
Preoperative digital orthopantomogram showing huge radiolucent lesion involving the entire body of the mandible on the left side
3DCT scan view showing huge osteolytic lesion with complete cortical bone destruction on the left body of the mandible
3DCT scan view showing huge osteolytic lesion with complete cortical bone destruction on the left body of the mandible - lingual side
Costochondral rib graft harvested to reconstruct the affected portion of mandible
Intraoperative view showing affected portion of the mandible
Infected portion of mandible removed with involved teeth
Huge cystic lesion along with the affected bone and teeth removed in toto
Harvested rib graft used to reconstruct the defective portion of mandible
Comments

Successful jaw reconstruction for Bangladeshi man suffering from extensive jaw cyst

9/2/2016

Comments

 
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.   
Comments

Extremely thin jaw bones reconstructed and rehabilitated with implants & prosthesis

8/2/2016

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A 25-year-old American came to our hospital seeking a fixed replacement for his missing teeth. He gave a history of having had multiple impacted teeth which were extracted before, elsewhere. Subsequently there was severe deficiency of bone in his upper & lower jaw due to which he was refused fixed teeth there.
A 3D CBCT scan taken revealed severely atrophied maxillary & mandibular bone. Maxillofacial Surgeon & Implantologist successfully performed the jaw bone reconstruction and dental implant replacement for his missing teeth in two stage procedure. Rib graft was harvested & used to reconstruct the thin upper & lower jaw bone.

After complete jaw reconstruction, dental implants were fixed in the reinforced regions of the maxilla & mandible. Following complete osseointegration of the implants with the surrounding bone, teeth prosthesis was fixed. The man is very happy to have fixed replacement of his missing teeth and to get back his confident, pleasing smile that remarkably improves his appearance.
Before treatment-multiple missing teeth & extremely inadequate bone
Before treatment-insufficient bone unsuitable for implants
3D CBCT showing severely deficient bone in upper and lower jaw
Rib graft harvested
Thin residual alveolar process in maxilla
Bone graft fixed to enhance the alveolar bone to receive implants
Implants fixed in the right upper back region of the jaw following bone grafting
Bone reinforced with graft and implants placed in lower jaw
Comments

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
Comments

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

9/7/2015

Comments

 
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
Comments

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
Bone grafted from iliac crest using trap door technique
Harvested graft used to reconstruct the residual bone defect
Surgical site closed
Comments

 Single stage Removal & Reconstruction of jaw tumor in a 1 year old boy for the first time and rehabilitation with dental implants

17/6/2015

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For the 1st time a rare type of aggressive facial and jaw bone tumor for 1 year old boy was removed through the mouth and the jaws reconstructed using rib graft, titanium mesh and bone morphogenetic protein. Rehabilitation was completed using dental implants and ceramic prosthesis to replace the missing teeth.  

A path-breaking surgery has helped an infant to recover from a facial disfigurement and life threatening ailment owing to a tumor in the jaw bone. The boy’s parents were very worried and they had approached many centers across the globe but the doctors there were hesitant to treat the one-year-old Maldivian boy due to the complexity of his condition. Dr. S.M. Balaji renowned for his expertise and dedication in Maxillofacial surgery successfully accomplished this complex task.

The Maldivian boy Saalik was 1 year old when he was referred to the hospital. He was suffering from a rare form of jaw bone disease called Osteodystrophy. It is a kind of tumor wherein the jaw bone dissolves gradually and gets replaced by soft tissues. Owing to this, his face was disfigured and his ability to eat and speak was becoming increasingly difficult. The disease severity was rapidly increasing from the time he was just 8 months of age.

Conventionally, for such cases, the only treatment is surgery which should be done when most of the growth ceases, i.e. at about 15 years of age. But in this instance, the extent of the tumor was vast involving the entire upper jaw and almost whole of lower jaw except the jaw joints. Distorted jaws will impede the growth of other facial bones also. Hence the only option was to intervene surgically immediately.

In a six-hour surgery, the diseased portions of upper and lower jaws were removed. A bone graft was taken from the boy’s rib and along with a customized imported Titanium plate was used to reconstruct the jaws. To enhance bone healing rhBMP-2 was also placed.

Recombinant human Bone Morphogenetic Protein is a scientifically prepared version of a protein that is already present in the body that promotes new bone growth. It stimulates the patients’ own cells to rapidly form new bone and quickly heals bony defects. This miracle protein also finds use in treatment of other maxillofacial defects like cysts and fractures. Other than the US, this centre is the only facility in this part of the world to adopt this technology with great success.

The widespread extent and severity of the disease and that too at such a young age complicated the problem. Microvascular surgery is tough due to the very fine blood vessel structures. Surgical strategies were planned meticulously using advanced CT scans. The innovative 3-in-1 surgery avoided the need for further surgeries. For the first time such an attempt to completely rehabilitate the tumor in a single stage was done.

The highlight of the surgery was that the entire procedure was done from inside his mouth so there will not be any visible scars on the child’s face. Following good new bone formation, his rehabilitation was completed with dental implants and fixed ceramic crown prosthesis to replace his missing teeth. He is able to eat and chew well. The boy’s parents are very happy that their child’s ailment has been successfully treated and that he is able to breathe, eat and speak well while at the same time his facial appearance is also normal again.

Saalik’s positive response and normal health have showed us how this surgery and stem cells treatment can be potentially used for reconstruction. 

Normal appearance of the baby at 6 months of age before tumor growth
Huge disfiguring facial swelling affecting the appearance and inability to close the mouth and speak properly
3DCT scan view showing complete destruction of the upper and lower jaw bone
Huge expansile bone tumor involving the entire maxilla was surgically exposed
Huge tumor was removed intraorally
Maxillary tumor mass in toto
Completely excised mandible along with the tumor mass
New bone formation following reconstruction of the jaw bone using costochondral rib graft and rhBMP2 bone protein
3DCT scan view showing good bone formation
Before and after tumor resection without any visible scars on the face
Dr. S. M. Balaji with the boy following successful jaw reconstruction
Implant fixation in the newly formed alveolar jaw bone
Dental implants fixed into the jawbone with good stability and retention
Cosmetically well blended implant prosthesis given
The boy and his parents are happy to have the tumor treated well without scar and for new teeth with implants
Comments

Complete jaw reconstruction of missing left side Mandibular ramus, condyle and temporomandibular joint to correct face asymmetry

10/4/2015

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A 13-year-old girl was brought to our hospital by her parents for specialized jaw reconstruction surgery. The girl’s lower jaw was deviated to the left side causing asymmetry of the face. Since birth the back portion of the left side lower jaw (Mandibular ramus and condyle) was missing causing difficulty in speaking and chewing. Also the lower jaw deviated to the left side while opening the mouth. The girl’s appearance was also affected making her self-conscious.

The 3D CT scan revealed complete absence of the posterior portion of the lower jaw left side. The left side jaw joint or temporomandibular joint was also absent. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the jaw reconstruction surgery. A costochondral rib graft was harvested and used to reconstruct the missing left mandibular ramus, condyle and temporomandibular joint. Immediately following jaw reconstruction, the face appeared symmetrical improving her appearance. The girl will require post-surgery physiotherapy to rehabilitate the jaw joint function. 
Preoperative facial view showing complete shifting of mandible towards left side leading to facial asymmetry
Preoperative digital orthopantomogram showing absence of mandibular ramus and condyle on left side
3DCT scan view showing complete congenital absence of ramus and condyle on left side
Preoperative mouth opening with jaw deviation towards left side
Costochondral rib graft harvested to reconstruct the structural and functional component of condyle
Harvested costochondral rib graft stabilized with the rest of the mandible
Immediate postoperative digital orthopantomogram showing reconstructed left condyle and ramus using rib graft
Comments

Successful removal and reconstruction of huge cystic lesion of lower jaw 

6/3/2015

Comments

 
A 32 year old man reported to our hospital with the complaints of swelling in the lower half of the face. He also said that this swelling was there for a very long period with occasional numbness.

After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed it as odontogenic keratocyst (OKC) involving entire body of the mandible on both right and left side. 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.
Digital orthopantomogram showing huge osteolytic cystic lesion involving the entire body of the mandible with many impacted supernumerary teeth
Preoperative 3DCT scan view showing osteolytic lesion involving the entire body of mandible
Costochondral rib graft harvested to reconstruct the affected portion of mandible
Intraoperative view where the cystic lesion was exposed and multiple impacted teeth were seen
Complete removal of cystic lesion with the lining
Cystic lining and multiple impacted supernumerary teeth and mandibular teeth removed in toto
Reconstruction of the affected portion of mandible with costochondral rib graft
Immediately after suturing
Comments

Successful jaw reconstruction & dental implants

25/2/2015

Comments

 
A young man from Middle East Asia suffering from Ectodermal Dysplasia was referred to our Hospital for expert care. He had complete missing teeth (anodontia) from childhood. Due to this there was progressive loss of alveolar process. He had consulted many dental surgeon for the same but due to reduced width and height of the alveolar process they refused to give dental  implant replacement for his missing teeth.  

Maxillofacial Surgeon and Dental Implantologist Prof. S.M Balaji performed the complete jaw bone reconstruction using rib graft & rhBMP-2. Implants were placed to replace his missing teeth in mandible. Following osseointegration of the implants, ceramic prosthesis will be given. Due to very thin alveolar process in maxilla, costochondral rib graft and BMP placed to enhance new bone formation. Later dental implants with good retention and stability will be placed after one month.
Intraoral view showing completely edentulous maxilla and mandible
3DCT scan view showing complete anodontia of both maxilla and mandible with thin alveolar process
Costochondral rib graft harvested to reconstruct the receded portion of alveolar process
Dental implants fixed in the lower jaw and stabilized with rib graft for good retention
Harvested rib graft along with miracle protein rhBMP2 used to reconstruct the alveolar process
Immediately after suturing following complete reconstruction of maxilla and mandible
Postoperative digital orthopantomogram showing graft stabilization and good dental implant retention in mandible
Comments

Jaw Reconstruction with recombinant technology for tumor resection

29/10/2014

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A 32 year old man reported to our hospital with the complaint of swelling in the right side of his face. He added that the size of the swelling was increasing progressively which made his face asymmetrical. He was very cautious about this progressive swelling which made him under huge depression.

After thorough clinical and radiological examination, Maxillofacial Surgeon  Dr. S. M. Balaji diagnosed it as ameloblastoma involving the right side angle and ramus of the mandible. Surgery was planned to remove the lesion and reconstruct the affected jaw portion in a single stage. Through submandibular incision, complete removal of the benign lesion along with the involved teeth with sufficient clearance of the bone under General anesthesia.  Long bone plate was fixed along with costochondral graft which was harvested was fixed to it. Miracle protein rhBMP-2 was wrapped over the costochondral graft to induce new bone formation. Incision was closed in layers. Patient was happy to have both removal and reconstruction in a single surgery. Postoperative OPG after 4 months showed good healing with healthy bone formation. 
Preoperative OPG showing huge lesion in the right angle and ramus region of the lower jaw
Preoperative facial view showing swelling in right lower half of the face
Costochondral graft harvested to reconstruct the affected portion of lower jaw
Gingivomucoperiosteal flap raised and affected portion of the lower jaw was exposed after stabilizing with long bone plate
Through submandibula incision wide excision of the benign lesion was done along with the involved teeth in toto
Lingual surface of the excised bone showing complete removal of the affected jaw bone along with the huge benign lesion
Harvested costochondral graft fixed with the bone plate
Harvested graft was wrapped with the miracle protein rhBMP-2 to induce new bone formation
Immediate postoperative view showing complete layer closure of the submandibular incision
4month postoperative OPG showing complete healing of the bone
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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
Comments

Failed bone graft for lower jaw treated elsewhere reconstructed successfully with rhBMP-2 

26/3/2014

Comments

 
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
Comments

Lower jaw fracture successfully treated after previous failed procedures done elsewhere

6/3/2014

Comments

 
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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