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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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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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Successful correction of disproportionately long lower jaw without any scars

27/6/2016

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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.
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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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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
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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
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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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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
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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Successful repair of ear tear and lower jaw fractures

1/6/2015

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A 38-year-old man had met with a motor vehicular accident in which he had sustained severe injuries to his right ear and lower jaw. His right ear was severely torn causing him great pain and he had much difficulty opening and closing his mouth.

A 3D CT scan showed right and left body of mandible fracture. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the reconstructive surgery. The mandibular fractures were fixed with bone plates and screws. The ear tear extended from behind the ear at the side of the neck, completely splitting the pinna till the skin of the preauricular region. The scar tissues were excised; the cut pinna was closely approximated and sutured restoring normal form and function. Following suture removal the right ear had a normal appearance and the man was very happy to have his injuries treated successfully. 

Severe cut wound in right ear due to trauma
Immediately after suturing
Immediately after suture removal following seven days of surgery showing complete correction of ear
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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 

6/3/2015

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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
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Successful jaw joint fracture stabilization – the growth centre in an eight year old boy

28/1/2015

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An 8 year old boy was brought to our hospital by his parents with the complaints of swelling and pain in both the jaw joints and inability to open his mouth due to an accidental fall from staircase.

After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S. M. Balaji diagnosed that there was a left condylar neck fracture with displacement. As the condyle is the growth centre for the lower jaw, Dr. Balaji planned to fix the fractured condylar segment into its correct position as early as possible.  Through preauricular approach the broken and displaced portion of the left condylar segment was fixed into its correct position using 4 hole titanium bone plate and screws. Proper bite is maintained by intermaxillary fixation for 2 weeks postoperatively. Thus, fractured condylar segment was stabilized to avoid any future mandibular growth related problems.  The boy is now on physiotheraphy for atleast a month to avoid trismus.
Preoperative 3DCT scan image showing left condylar neck fracture with displacement
Postoperative digital radiograph showing condyle fracture stabilization and intermaxillary fixation for healing betterment
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Successful treatment of lower jaw fractures sustained in a vehicular accident

28/11/2014

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Preoperative 3D CT scan image showing left mandibular angle fracture
OPG of the patient showing the two mandibular fracture lines
Completely deranged occlusion due to fracture causing inability to bite, chew, swallow, speak
Fracture segments stabilized with bone plate and screws on the right mandible
Left side fracture stabilized and plated
Proper occlusion and bite achieved with successful treatment
Postoperative radiograph showing successful fixation and stabilization of fractures immediately after surgery
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. The fractured tooth in the line of fracture was extracted. Accurate occlusion and bite was achieved. Postsurgery radiograph showed optimum fracture fixation. 
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