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