​This young boy fell from a chair directly onto his chin when he was around 2 years of age. He had suffered a minor cut to his chin, which was sutured at a local dispensary at his hometown of Kangeyam, a town famous for bulls in South India. A minor pain had persisted in his temporomandibular joints, but his parents had ignored his complaints. He too had stopped complaining after a while and the incident had been forgotten.
As the boy grew up, his parents had begun noticing a developing asymmetry to his lower face. His mandible was slowly begun deviating to the right side with the right side of the mandible being shorter than the left side. He had slowly begun developing chewing problems and speech problems, which progressively became worse with time.
They took him to a local oral surgeon who ordered an OPG of his jaws. This revealed that the patient had ankylosis of the right temporomandibular joint. The surgeon had referred the patient to Balaji Dental and Craniofacial Hospital in Chennai as it was a specialty center for TMJ ankylosis surgery in India.
Dr SM Balaji examined the patient and formulated a treatment plan, which was explained in detail to the patient’s parents. The patient had an asymmetric mandible because of the long standing ankylosis of the right temporomandibular joint. This would have to be corrected through jaw reconstruction surgery with the use of distractors, but the ankylosis release surgery had to be performed first. They consented for surgery and the patient was scheduled for ankylosis release surgery. Surgery was performed successfully and the TMJ ankylosis was released. The second stage of the treatment plan would be distraction osteogenesis.
The patient had impacted lower left third and lower right second and third molars on presentation at this time. It was explained to the parents that these had to be extracted before performing the distraction osteogenesis surgery for the mandible. Upon consultation with the anesthesiologist, it was decided to induce anesthesia through nasal fiberoptic bronchoscopic intubation as the patient had very minimal mouth opening.
The patient was prepped was surgery and anesthesia was induced through nasal fiberoptic bronchoscopic intubation with a certain degree of difficulty. Once anesthesia was established, the impacted molar teeth were extracted without event. The patient recovered uneventfully from anesthesia.
It was explained to the parents that the extraction sockets had to heal completely with filling in of bony tissue. This bone had to get consolidated fully with normal trabecular architecture as surrounding bone. Once radiographic evidence of this had been confirmed, the patient would be scheduled for distraction osteogenesis surgery. The patient’s parents were in full agreement with the treatment planning and were scheduled to return back to the hospital in approximately six to eight month’s time.

Patient with long standing facial asymmetry due to hemifacial microsomia

This young man who is from a small town in Maharashtra first began noticing a gradually developing facial asymmetry for a few years now. He also began noticing that it was progressively becoming difficult to chew and speak compared to a few years ago. This had led to him developing avoidance behavior with regarding to meeting people and eating certain classes of foods. His day to day functioning was becoming affected by this and he was becoming very worried by this problem.

This asymmetry also made him develop the habit of tilting his head until it nearly touched his shoulders to conceal this facial asymmetry from casual observers. He developed severe neck spasms as a result of this debilitating habit of tilting his neck. This neck pain was keeping him up at night and this lack of sleep was making him irritable. He was also feeling chronically angry at this turn of events in his life. This problem was slowly beginning to consume his thought process and affect every aspect of his life including his professional life.

Deciding that something had to be done about this, he and his parents met an oral surgeon to get to the root of the problem and also to find out the cause of the severe neck pain. The surgeon explained that the patient had very prominent facial asymmetry and that his occlusal cant was also askew. His diagnosis for the patient was hemifacial microsomia. He said that the patient required facial asymmetry correction surgery.

​He educated them on the various aspects of treatment available to the patient and said that they needed to go to a specialty center for facial asymmetry surgery in India. The patient and his parents were thus referred to Balaji Dental and Craniofacial Hospital in Chennai, India for definitive surgical management of his problem

Treatment planning explained and consent obtained for distraction osteogenesis
Dr SM Balaji met with the patient and obtained a detailed history. This was followed by detailed imaging studies including a 3D CT scan. Facial biometric scan was also obtained in order to make treatment planning easy. This revealed a ramus that was shorter by 10 cm on the left side when compared to the right. Planned surgical intervention would be through simultaneous maxillary and mandibular distraction for setting right the problem for the patient. The rationale behind treatment planning was fully explained to the patient and his parents who expressed understanding and agreed to surgery.

Bilateral sagittal split osteotomy of the mandible
Sagittal split osteotomy was performed on the left mandibular ramus after successful induction of general anesthesia. A Univector ramus distractor was then utilized for the distraction osteogenesis. This was fixed with screws to the two side of the distracted segments of the mandible. Distraction functioning was deemed to be adequate after a thorough check and the incision was then closed with sutures.
Maxillary distraction followed mandibular distraction. A Le Fort I maxillary osteotomy was performed through a vestibular incision. Left sided dysjunction of the maxilla followed by stabilization of the two distracted segments was performed.

Establishment of facial symmetry through distraction osteogenesis
A latency period of seven days would be followed by distraction osteogenesis of the mandible. This period was for stabilization of the distracted site. A distraction of 1 mm would be performed each day for a total of 10 mm of distraction in ten days. The distractors would then be left in place for a period of three months for the new bone to consolidate at the distracted site.
This would result in establishment of facial symmetry for the patient. The patient and his parents expressed their satisfaction at the results of the surgery before final discharge from the hospital.

This video series contains gross images, graphic descriptions of gore surgical procedure. Viewer’s discretion strongly advised. Cannot be substituted for a professional medical/surgical advice

This is a case of a 32-year old male, a victim of road traffic accident. The entire right mid-face skeleton was lost exposing the underlying structures including nasal and mouth being exposed. He was unsuccessfully and repeatedly operated at several centers using distant flaps and micro-vascular surgeries. He had graft taken from abdomen, various regions of arm, legs, back and shoulders. All the grafts resulted in total failure. With each attempted surgery, more areas became involved leading a huge scarring and defect.

The immediate goal was to provide a structural cover and to close the defect with skin. As the entire vascularity of the area was compromised and no significant donor site available, a local forehead rotational flap harvest was chosen. After adequate preparation a medial forehead flap was raised and rotated to cover the defect of the right midface. Layer-wise suture was performed. The entire right midfacial defect was successfully closed

This is a 1-year old Karachi, Pakistan boy who was born with the Tessier Type 4 cleft involving the bilateral palato-labial-orbital surfaces. My immediate goal was to reconstruct the lips and correct the orbital defect. The right eye had some partial vision while the left eye was congenitally defective. Also, the part of the surgery was to help to save the vision in the right eye.
After successful intubation, the surgery was done in three steps – the labial part, the orbital part and the nasal area.
In the labial part, the aim was to provide a good columella, philtrum, cupid bow with a near perfect vermillion surfaces. I employed a modified Paul-Black’s technique. With adequate reflection of mucosa, approximation was performed. The recreation of a perfect labial sulcus was crucial. Simultaneously, perfect muscle sling created by orbicularis oris muscle was performed. At the end of surgery, normal labial surfaces achieved at both halves of the face.
After the successful completion of the labial part, the orbital part was done. The incision was started from the lower eyelid. Excessive eye tags were incised, a part of which was utilized to recreate the outer canthus of eye. The excess tissues were removed. The lateral canthal ligament interposition was ensured.
In the next stage, the reconstruction of the nasal area along with the repositioning of the medial canathus of eye was performed. During this stage care was taken to ensure that the patency of punctum was preserved. Also efforts were drawn to keep the patency of the nasolacrimal duct intact. This would ensure proper wetting and lacrimation, an essential feature to save the vision in the right eye.
As the left eye was poorly developed, an artificial bio-compatible conformer was placed and the eyelids reconstructed as in the right side. Later a plastic shell, mimicking natural eye would be placed. By this the child would have a normal appearance and would not have any stigma attached.
 
By these procedures, the child would develop normal speech, normal social skills and peer interaction also this surgery would avoid social stigma attached with such defects. The child would have a normal childhood.

This is a case of 22 year   female patient   who reported to us for prosthetic rehabilitation of her lower jaw.  She is a diagnosed case of ectodermal dysplasia with complete anodontia of lower arch and partial anodontia of the upper arch. CT scan demonstrating the edentulous atrophic mandible.

We can see the mental foramen along the superior border of the mandible.  The dental rehabilitation of the patient was planned using implants for which adequate alveolar height   is required. Hence alveolar distraction of the symphyseal region was planned. Under nasoendotracheal intubation,  crestal incision was placed from 36 to 46 region and full thickness flap reflected. The mental nerve was identified and carefully protected. Horizontal osteotomy cut was marked along the buccal cortex and the vertical osteotomy cut is marked  above the mental nerve.  Distractor device positioned and fixed.  Osteotomy   is then completed along the lingual cortex. The device is checked by distracting the segments.  Wound closure done. Patient  extubated, recovery spontaneous and uneventful. 

This is a case of a 22 year old male patient who reported to us for the surgical correction of asymmetry over the left side of the face. Facial asymmetry may be present in cases of hemifacial microsomia, TMJ ankylosis or may have resulted following condylar fractures. This patient had a madibular deficiency at the ramus level and deficiency measured almost 17mm with a resultant occlusal cant. Hence a maxillomandibular distraction was planned using internal distraction osteogenesis to lengthen the ramus and to correct the occlusal cant as well.   

Under nasoendotracheal intubation, general anaesthesia was induced.  Paragingival incision was placed over the left angle region along the anterior border of ramus. Full thickness mucoperiostal flap was reflected buccally and bone exposed. Reflection of the lingual tissues done minimally to protect the inferior alveolar nerve. Horizontal osteotomy done inferior to the anti lingula over the buccal cortex. The direction of the osteotomy cut and positioning of the distractor is the most important as it determines the vector of distraction.  The vector determines the direction of the bone growth. The distractor device positioned and fixed using screws. Osteotomy is then completed along the medial cortex. Distractor device checked and wound closure done. Le Fort I osteotomy completed in maxilla. Patient extubated, recovery spontaneous and uneventful.  After a latency period of 5 days, IMF was done and distraction at the rate of 1 mm per day was accomplished. Over correction of about 21 mm was done so as to compensate for any relapse that may occur. The post-operative CT image demonstrating the correction achieved.

This is the 2nd stage of the ear reconstruction. In the previous stage of reconstruction, the cartilagenous grafts were harvested carved and they were banked in the donor site. Additional, excess cartilages were also banked in the site, which would be latter serve as stops.

After adequate healing, in this 2nd stage, the inserted cartilagenous graft was identified. Clear, precise incision to simulate the pinna outline was drawn. Using careful elevation, and use of excess cartilageal blocks, the reconstructed pinna was lifted and positioned. Pericranial tissues have to be left intact and adequate care need to be exercised. This elevated flap was debulked to resemble the normal external pinna.  Resorbable sutures were carefully placed to simulate the rolled margins. The defect left behind has to be closed – either by a temporal flap or a similar approach. In the present case, simultaneously, a full thickness graft was raised from the groin region. Excess fat tissues and adnexial structures were carefully removed. The donor site was closed in layers. This full thickness graft was then carefully placed and sutured accordingly in layers.

This step results in a successful creation of 3D soft tissue contour. Later in the 3rd step, the lobule of the pinna will be repositioned to complete the ear reconstruction

A man in 5th decade of life complained of a huge odontogenic tumor, diagnosed as Adenomatoid Odontogenic Tumor sought removal of the lesion. His concern was post-operative defect and preferred not to have a scar in his face. The size of the tumor can be appreciated in the CT scan while OPG would show the shifting of the teeth due to tumor. 

The treatment plan was to remove the entire tumor with adequate marginal clearance through his mouth thereby avoiding unsightly scar. A gingival crevicular incision was placed along the entire length of the tumor exposing the entire tumor. 
An appropriate plane of cleavage was identified and the tumor was completely isolated by blunt incision. To facilitate and minimize post-operative defect,preservation of mucosa was desired. This would also prevent formation of fistulas and also help in proper feeding and speech. 

The tumor was slowly mobilized in segments and the tumor was removed as a full mass. The margins were trimmed and the sinus lining was cleaned. The sharp bony margins were trimmed.
The defect was stuffed with cotton gauze dipped in Betadine. One free end of the gauze was retrieved through the nares, so that it could be removed three days latter. The mucosa was closed in layers. The gauze ensured prevention/ accumulation of blood as also reduced the chance of hematoma. Three days after, the gauze was removed. 

The correction of the defect could be appreciated in the post operative image.

A 60 year old male sought reconstruction of his mandible. Three years earlier, he had been operated on for squamous cell carcinoma. He lost a large part of his mandible, floor of mouth and adjacent tissues. He lost a substantial amount of oral tissues. Hence a rotated deltoid, myocutaneous petrolis Major flap was used to close the defect after tunneling the flap. 
Before the surgery presence of resiudal tumor was ruled out by PET scan and other investigations. 

As the scar tissue was compressing the entire area, there was no space. hence the first goal was to create a sufficient space. For creation of this space, a custom made distractor was fabricated. This was used to perform distraction histogeneisis. This resulted in formation of new tissues in the center. After adequate space by formation of new tissues, a bilateral transport distraction was planned. 

After careful dissection, the cut end of the mandible were identified. Old rigid fixation plates were removed. A section was cut from the buccal cortex while preserving lingual cortex. After adequate split, the custom fashioned long plate was adapted to his mandible. This titanium plate was fixed to the mandible. After ensuring fixation at both ends, in the split portion of mandible, the distractors were screwed with small screws. The opening and closing of the distractors were checked.At the end, the lingual splits were partially completed.  

After 5 days, the distractors were activated resulting in formation of new bone at the split ends at a rate of 1 mm per day. The partial lingual split ensured adequate blood supply to the newly forming bone.

Microtia is a congenital condition in which there in poor development of ears. Microtia correction involves staged reconstruction of the ear using autogenous costal cartilage.  Shown is a case of microtia with partially developed ear and a closed (stenotic) external ear canal producing a conductive hearing loss. These cases requires  multiple stages of surgery  where in costal cartilage is harvested  and contoured to form the external framework and positioning  is done in the first stage followed  and ear lifting  and keyhole surgeries at a subsequent stages.

The 92nd Annual Conference of the International Association of Dental Research (IADR) was held in Cape Town, South Africa. This is the highest world forum on dental research where globally renowned researchers are invited to share their expertise. Craniofacial Surgeon Dr. S.M. Balaji was invited to this meet to present his research works in the management of facial deformities. He presented his extensive works in the treatment of Hypertelorism highlighting the efficacy of his modified surgical technique for improved results & good long-term stability.

The world's highest body in dental research is the International Association of Dental Research (IADR) with head quarters in USA. The association has about 12,000 members worldwide. The 92nd Annual Congress of this scientific body was held during June 25th -- 28th 2014 at Cape Town, South Africa. To increase the quality of dental research and research manuscript across the globe, the IADR had organized a symposium to deliberate and identify possible solutions. 
In this symposium, Prof. S. M. Balaji, as Editor-in-Chief, Annals of Maxillofacial Surgery & Executive Editor, Indian Journal of Dental Research was invited to represent the Asian region in this one of its kind scholarly program. The Symposium was chaired by Prof. Kenneth A. Eaton, United Kingdom, Chairman of the British Dental Editor's Forum. The other prominent faculty was Prof. William Giannobile, USA, Editor-in-Chief, Journal of Dental Research.

A 28 year old female met with a Road Traffic Accident. Radiographic and clinical examination exhibited evidence of multiple fractures of facial bones and lacerations. The mandible and zygoma were broken. A non-blow out, tripod fracture with a good orbital volume was observed in the cheek area. The plan of the surgery was to make the mandible in to a single bone, then correct the hollow area of the cheek bone. Lastly, the superficial wounds were to be fixed. 

During the surgery, the fractured segments were approximated, a temporary Inter- Maxillary Fixation (IMF) was done to achieve harmonious occlusion, and a rigid fixation method using 4mm stainless steel plates was used to fix the fractured area. After this, the temporary IMF was removed. 

The step deformity in the cheek bone (Zygoma) was approached using the subciliary incision.  The fronto-zygomatic sutural area was identified. Using appropriate elevators, the fractured zygoma bone were elevated and approximated. The step deformity in the infraorbital rim was approximated through the subciliary incision. Trans-osseous wiring was employed to keep the approximated bones in place. The step like deformity was corrected. Using a 6-0- Ethilon suture, the superficial wounds were closed in layers. This ensured minimal scarring by about 6 to 8 weeks

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.

The launch of rhBMP2 in the Indian subcontinent was done in 2008. The rhBMP2 is a unique protein that helps to stimulate the latent osteocytes to get activated and produce bone. The rhBMP2 also attracts progenitor cells to differentiate in to osteoblasts. These cells in turn produce normal bone. This unique protein was identified in late 1980s and produced commercially in late 2000s. This product was finally endorsed by authorities and launched in India. Balaji Dental and Craniofacial hospital was the first center in India to incorporate this protein for facial reconstruction in South East Asia. Dr. S. M. Balaji, performed the first such innovative surgery in the Indian Subcontinent.

Facial defects could be congenital like cleft palate or due to trauma, road traffic accidents or cancer surgeries. In this novel technology, the necessary for a bone donor site – hip bone or the rib bone is eliminated. This harvesting procedure has some potential issues besides giving an unsightly scar. The placement of rhBMP2, in the area of the defect, the material is packed. This material stimulates the dormant cells in the bone as well as attracts circulating monocytes to differentiate in to bone forming cells. Latter in 3 to 6 months time, the bone is fully formed in the defect. Prof. Michael Carstens from USA has been a pioneer in this and been to India exclusively for this launch. He briefed the trauma and pressure from cleft and how this new product offered relief. 

Cone Beam Computerized Tomography or the CBCT is the latest addition in craniofacial Surgeon's diagnostic equipments. The single most advantage of this equipment is its low dose radiation as compared to other standard imaging equipments. As compared to a standard CT scan, CBCT uses lesser radiation to scan the oral and craniofacial regions, which is comparable to standard orthopantamogram. In complex situation that needs repeated 3D imaging requirements, in a short span of time, CBCT provides lesser radiation and therefore offer better safety margin than any other techniques.

This latest equipment was integrated in to regular dental practice at Balaji Dental and Craniofacial hospital. This was for the benefit of young children requiring complex treatment as well as those dental implant patients requiring 3D visualization of the existing structures. Adequate treatment planning and margin visualizations help in a better way for effective treatment delivery.

The inauguration of this facility at Balaji dental and Craniofacial hospital was held on 2nd October 2010. The machine was dedicated by Padma Shree His Excellency Dr. D. Y. Patil, Governor of Tripura at the hospital premises. This was the first machine to be introduced in to clinics in South India and 2nd Machine in India. This technology would be immensely beneficial to the patients