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.

​Difficulties faced – in patient’s words

​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.

​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.

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.

​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.

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.

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.

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.

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

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.   

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.

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.

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.

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. 

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.

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.

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.