This is a case of a young female with a bilateral cleft lip and palate whose nose was treated elsewhere unsuccessfully. There was a short and broad nose along with a short prolabium. The goal of the surgery is to revise the previous correction, to increase the length of columella, create a narrow and longer nose. A costochondral graft was planned. This graft was harvested through the previous scar avoiding another scar. The 7th rib was identified and appropriate amount of graft harvested.  
For the columellar lengthening, the short prolabium was elevated. The medial and lateral crurae was identified and the lower lateral cartilage was reached through the incision. Through this the degloving of the nose was done. The short prolabium was used as a base for the columella lengthening. A medial and lateral osteotomy of nasal bones was performed. This ensured a narrowing of the broad nose. The broad dome was approximated with a interdomal suture.
A portion of the costochondral graft that was harvested was sculpted in to 2 pieces. The large one was used for augmenting the dorsal portion of the nose. The smaller graft was used as a sturt graft and increase the height of the nose. This was latter secured in its place and anchored to the anterior nasal spine tightly. The medial and lateral nasal crurare were approximated and sutured. An alar sinching was done to ensure a reduction in the base of the nose and secure it in its new position.
The defect in the base of the columella was corrected with a carefully planned Abbe flap, that was demarcated, raised with appropriate blood supply from lower labial vessels. This lip flap was then lip switched to the upper lip. The rich vascular base ensured proper blood supply while the vermilion border of lower lip resembles that of the upper lip. The flap was secured in layers. The result was a well formed nose that was narrow, of appropriate dimension while the lip area had normal color and appearance. 

This is a 10 months old baby with an isolated cleft of hard and soft palate. This is one of the milder versions of the palatal clefts. To close this type of cleft, an intraoral approach is done where in a vomerine flap is raised. The nasal layer is raised. Through the incision on the hard palate, a palatal flap is also raised. The greater palatine artery is exposed. At this juncture, the nasal mucosa is carefully separated. An osteotomy of the greater palataine foramen and canal is carried with great dexterity to prevent post operative tension that could lead to potential problems. The medial and lateral flaps of the mucogingival flaps are also carried out. Using a Howarth Elevator, the palatal mucosa is elevated. Care is exercised not to disturb the tooth buds. While operating in the opposite or the contra lateral side, the left hand is used for incising. Hence this surgery would be best performed by an ambidextrous surgeon. The nasal mucosa is sutured to create an ideal nasal cavity.
The muscle attachments are carefully identified. The leveator palati is detached and the correct attachment is performed. Throughout the procedure, the greater palantine vessels are carefully handled. The muscle sling is established. The greater palatine artery is moved away from the canal to aid in repositioning of the flap.
At the end of this procedure, suturing is commenced from Anterior to Posterior direction then towards the uvula. A horizontal or a vertical mattress type of suture is placed. Dead space between nasal and palatal mucosa should be eliminated. For this reinforcement bite is placed even from the nasal mucosa

This is a 16 year old female whose upper jaw was not properly developed giving rise to a concave face. Instead of the upper jaw growing out and downwards, there is a static phase of growth leading to a concave profile. Because of this, the patient looks prematurely aged.

The aim of the surgery is to create a pleasant smile and appearance by bringing the entire upper jaw outside and creating a harmonious facial profile. For this a modified Le Fort1 ostetomy was planned. The standard cuts are modified and hence a bur was used to make the cuts instead of the saw. After placing adequate cuts, the down fracture of Maxilla was done and separated from nasal septum. The entire maxilla is brought forward in such a way that there is a complete elevation of the alar base so as to give a proper nasolabial prominence. After achieving a perfect forward positioning of the upper jaw, temporary fixation with wires were carried out so as to produce stable results. After achieving proper occlusion and at final position, the maxilla was rigidly fixed using plates and screws. Before closing the incision, an alar sinching is done to prevent the appearance of a broad alar base. When perfectly performed, the nasal appearance will be preserved. After this the incisions were properly closed. The wires are removed at the end of the surgery and patient can have a comfortable life from then on. At the end of the surgery, patient will have a normal profile. Appropriate Antibiotics and pain killers will be provided to prevent the pain and swelling.

Wisdom tooth is the last permanent tooth to erupt in to the oral cavity around 18 to 25 years of age. When there is no sufficient space for the tooth to erupt or due to lack of eruptive forces, these tooth fail to erupt. Some time the teeth gets fully buried and more often partially erupts in to the oral cavity.
The accumulation of plaque or microbiological agents in the space between the impacted teeth and gums gives rise to condition called "Pericoronitis" causing pain and infection. As age increases, the bone becomes thick in the region making surgical procedure tougher; the repeated pericoronitis cause functional malocclusion resulting in joint pain. Moreover the prolonged impacted teeth are susceptible to give rise to odontogenic cysts and tumors.
The procedure to remove the impacted wisdom teeth is a simple and safer procedure. A careful assessment of the teeth, bone and adjacent is made by studying the OPG or the jaw x-ray, a cone beam CT or a CT itself.
After assessment, the bone lying over the impacted tooth is carefully removed. Minimal removal of tooth is essential as preservation of bone will aid in faster healing. Hence sacrifice of tooth or splitting of tooth is preferred that bone.
As it can be observed, in this case, the crown or the upper portion of tooth is split and through this space, the roots are carefully removed. The socket cleaned of debris and the closed with sutures. Similar procedure is done on both sides. Depending upon the amount of bone to be removed post-operative swelling may occur. For milder cases, regular work may be resumed on the next day itself. Pain and swelling are usually controlled by regular pain killers and appropriate antibiotics prescriptions.

This is a case of facial asymmetry caused by developmental abnormality -- Hemifacial Microsomia that cause smaller lower jaw as seen in the 3D CT. The entire half of the corpus of mandible is smaller. The surgery need to be performed through intraoral approach. The aim will be to lengthen the mandible in the affected side; simultaneously by Le fort 1 maxillary osteotomy to correct the occlusal cant.

After raising the flap and visualizing the smaller side of the mandible, the distractor was adapted to the bone. The placement site was determined and mock placements were performed on the bone. Guiding screw holes were placed so that distractors could be placed as previously determined. The active arm was decided to be placed through a hole created in neck. This placement ensures convenient vector, ease of operation, minimum discomfort as well as no instance of distractor arm breakage. After this step, the mandible was cut along the predetermined line. Refit of distractors at previously decided site was done and secured. Distractors was checked. One complete turn ensured lengthening of 0.5mm.

After this, standard maxillary Le fort 1 surgery was done on the affected side. Pterygoid dysjunction was performed only on the affected side. Inter Maxillary Fixation was performed. Appropriate hinge screws and wireloops were placed. The incisions were closed. On operating the distractor, both the maxillomandibular corrections was ensured. After consolidation, asymmetry was corrected.

This 20 year old female complained of a short lip causing inability to close the lip completely resulting in a "gummy smile". On examination, excess of vertical height of upper jaw or the maxilla was observed. The aim of correction is to reduce the vertical excess of the upper jaw so as to create normal smile for the patient.
After adequate study, under general anesthesia and standard preparation, through the mouth the surgery was carried out. Surgical incision was placed in the upper vestibular and nasal mucosa till the pterygoid region. The jaw bone is exposed. The Le Fort I standard cuts were placed using saw.  Using septal divider, the septum was disengaged. Spreader was used to split the cuts. Down fracture of the Maxilla was performed.
Excess of the vertical height of 10 mm was reduced along the all related areas appropriately. Part of the nasal septum was also removed as a normal septum would bend after approximation of the maxilla creating a compromised airway. After this the maxilla is shifted upwards. Bone fragments were fixed with plates and screws. While closing the incised area, alar base sinch was secured so as to prevent the nasal alar base appearing wider.
The initial healing period is for two weeks. A normal smile was created for the patient.

Complex craniofacial diseases and deformities require complex, multistage treatment. One such complex disease that cause craniofacial tissue developmental disturbance is the Hemifacial Microsomia, where in the entire half of the mid-face and lower face is ill developed. This leads to improper facial growth, poor facial esthetics and functional compromise at a very younger age itself. The patient shown here in is a female in her early twenties whose parents were worried about her appearance. They had gone elsewhere and the case was mishandled with multiple surgeries, as seen in the 3D reconstruction and radiographs. The imaging showed a shortened mandible with poorly developed Tempromandibular joint. The case was managed by intra-oral distraction with no additional grafts. The advantage was that the entire surgery was done using an intra-oral approach that eliminated external scar. Secondly, no additional grafts were procured there by the secondary scar either at the rib region or the hip region was eliminated.

Through an intra-oral approach, a vestibular incision was made on the affected side. An osteotomy cut was made. The arms of the intra-oral distractor were adapted to the bone. The distractor was secured with screws and slowly distracted. The CT shows the distractor in position and gradual distraction causing lengthening of the mandible. In due course of time, the patient had better esthetic and functional efficiency.