Le Fort I for Hypoplastic Maxilla and Dental Implant Surgery
Young man with maxillary retrognathism from cleft lip and palate deformity The patient is a 16-year-old male from Ankleshwar in Gujarat, India. He had been born with facial deformity comprising of bilateral cleft lip, palate and alveolus. This had resulted in him having a split maxilla. There was a communication to the nasal cavity at the roof of the mouth. The gynecologist had referred them to the dental wing of the hospital. She counseled the parents that a baby with cleft deformities would grow up to be a normal adult. The parents had presented to the dental surgeon at the hospital. He had advised them to follow the predetermined surgical schedule for cleft repair. They had then been referred to us by the dental surgeon. Our hospital is renowned for cleft lip and palate surgery in India. We are recognized as a regional affiliate of the International Cleft Lip and Palate Foundation (ICPF) of Japan. This surgery is mainly performed by Oral and Maxillofacial Surgeons in India. Plastic surgeons also perform this in countries like the US and European countries. The patient had undergone cleft lip surgery at 3 months and cleft palate surgery at 9 months in our hospital. This had been followed by cleft alveolus repair at 3-1/2 years of age. Both cosmetic and functional results from the three surgeries had been optimal. He had been referred to a speech pathologist for speech training and had developed good speech patterns. Gradually worsening maxillary deficiency with resultant facial deformity The patient had met all his developmental milestones appropriately. He was able to feed well and his speech development was also normal. However, as her grew older, his maxillary growth was deficient with resulting backwardly placed upper jaw. This made it very difficult for him to eat and he felt that it was compromising the esthetics of his face. He had an anterior skeletal crossbite. This had caused significant esthetic compromise to his facial appearance. His parents had presented back to our hospital for correction of this problem. He also had a hypoplastic maxillary left central incisor and missing lateral incisor. He had undergone bone grafting at 11 years of age. This was to create adequate bony support for placement of an implant at the site of the missing tooth. Patient presents at our hospital with his parents Dr SM Balaji, facial reconstruction surgeon, examined the patient and ordered comprehensive radiological studies for the patient including a 3D CT. Clinical examination revealed an anterior maxillary crossbite. The maxilla was also backwardly placed and with a narrow arch. His 3D CT revealed a split maxilla with maxillary hypoplasia. Common causes for maxillary hypoplasia Maxillary hypoplasia is caused by underdevelopment of the maxillary bones, which produces midfacial retrusion and creates the illusion of mandibular prognathism. It is associated with Crouzon syndrome and Angelman syndrome as well as fetal alcohol syndrome. This is also a feature of many patients with repaired cleft lip and palate deformity. A rarer etiology for this deformity is traumatic maxillary dental extractions. Treatment planning and surgical correction of maxillary retrusion It was explained to the patient that his retrognathic maxilla would be advanced through a Le Fort I procedure. The maxillary segment would be stabilized using titanium plates and screws. His split maxilla would be brought together. This would be followed by extraction of the malformed central incisor and placement of dental implants for the two incisors. The patient was in agreement with the proposed treatment plan and consented to surgery. Under general anesthesia, a crevicular incision was made in maxilla followed by elevation of a mucoperiosteal flap. Extraction of the left central and lateral incisors was then performed followed by implant placement at the extraction site. This was followed by Le Fort 1 bone cuts to the maxilla and the maxilla was downfractured. The maxillary segment was then pulled outwards and checked for occlusion. Once occlusion was deemed to be adequate, the maxillary segment was fixed using titanium plates and screws. Closure of the incision was then done using resorbable sutures. Outcome of the surgery was as planned and the maxilla was now normally positioned in relation to the mandible. Patient expresses his satisfaction at the results of the surgery The patient was very happy with the outcome of the surgery and thanked the surgical team. He expressed that his facial appearance had been transformed by the surgery with good esthetic results. His parents stated that there has been a perceptible increase in his levels of self confidence. They were also very happy with the outcome of the surgery. The patient and his parents will return in three months for placement of ceramic prostheses on the implants. They expressed their thankfulness before discharge from the hospital. Surgery Video
Dental Implant Surgery – Reconstructed Jaw with Bone Grafts
Patient presents with odontogenic keratocyst of left lower jaw The patient is a 28-year-old female from Tuticorin in Tamil Nadu, India. She developed a progressively enlarging growth in her posterior left lower jaw around six months ago. This was also associated with pain and caused difficulty with eating and speech. She had presented at a local hospital where x-rays had been obtained. Her provisional diagnosis was odontogenic keratocyst and she was referred to our hospital for management of her condition. Etiology of odontogenic keratocyst and its implications An odontogenic keratocyst is a benign but locally aggressive developmental cyst. It most commonly occurs in the posterior region of the mandible in the third decade of life. They comprise around 19% of jaw cysts. It first manifests as a swelling with development of pain in the affected region. Rarely asymptomatic, it can also be an incidental discovery in unrelated dental radiographs. Surgery has to be performed to remove the cyst. Teeth in the involved region are extracted. The patient later undergoes dental implant surgery with placement of zirconium crowns. Removable dentures are rarely used since the advent of dental implants. Initial presentation at our hospital for management of her lesion Dr SM Balaji, cyst removal surgeon, examined the patient and obtained radiographs of the region. He also ordered for a biopsy, which confirmed the diagnosis of odontogenic keratocyst. The patient subsequently underwent left mandibular marginal resection along with removal of teeth in the affected region. The patient also underwent reconstruction of the region utilizing rib grafts that were harvested from the patient. These rib grafts were crafted into the right shape and fixed in place using titanium screws. The patient was advised to return in six months for dental implant surgery. This would complete rehabilitation of the patient with restoration of lost teeth structures with the implants and crowns. Patient presents after six months for dental implant surgery The patient presents now for her dental implant surgery. Radiographs including OPG and 3D CT scan were obtained at this time to evaluate the healing of her bone grafts. Radiographs revealed good consolidation of the bone grafts with the residual jaw bone. The patient was advised that it was the optimum time for her to undergo placement of Nobel Biocare dental implants as previously planned. Successful placement of dental implants at the site of bone graft Under general anesthesia, an incision was made in the left posterior mandibular region at the site of the previously placed bone grafts. A flap was elevated and the titanium screws holding the bone grafts were removed. There was good integration of the bone grafts with the mandibular bone. Attention was next turned to placement of the Nobel Biocare dental implants. Dental implant surgery was performed with three dental implants. These were placed in the bone corresponding to the sites of the left lower second premolar and first and second molars. Once optimal placement of dental implants had been confirmed, hemostasis was achieved and the flap was sutured using resorbable sutures. Total patient satisfaction with the results of the surgery The patient expressed her happiness at the successful completion of the surgery. She said that she had been very depressed following the diagnosis of odontogenic keratocyst. Her greatest fear had been about residual facial deformity following surgery. She said that all her fears had been laid to rest and she was confident that her quality of life would not be diminished by this. The patient further expressed that she was looking forward to returning in three months for Zirconium/ceramic crowns on the dental implants. She conveyed her thankfulness to the surgical team before discharge from the hospital. Surgery Video
Carcinoma of Lower Jaw – Infected Plate Removal Surgery
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Patient diagnosed with carcinoma of the lower jaw” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient is a 56-year-old male from Alwar in Rajasthan, India. He had been diagnosed with right mandibular carcinoma and had undergone a hemimandibulectomy at a nearby city. The missing section of his mandible had been reconstructed with a fibular graft and reconstruction plate with condylar head. This had been approximately two years ago. He had subsequently undergone chemotherapy and radiotherapy with complete resolution of his cancer. The patient had had difficulty with eating and speech following surgery. There was also facial asymmetry following surgery. The reconstruction plate however became exposed around six months following the resection. Gradually worsening over time, this had become an exposed wound with drainage of pus. The patient was greatly distressed by this. This had reached the point where it had become intolerable to the patient. He had been in constant pain because of this. His family had made widespread enquiries regarding the best hospital for jaw surgery in India. They had subsequently been referred to our hospital for management.[/vc_column_text][vu_heading style=”2″ heading=”Initial presentation at our hospital for removal of his infected plate” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji, jaw reconstruction surgeon, examined the patient and ordered for radiological studies. Clinical examination revealed that the patient had an exposed plate in relation to the right mandible. There was also drainage of pus from the site. The patient also had associated inflammation at the site of the exposed plate. There was also trismus with inability to fully open the mouth. The 3D CT scan revealed significant signs of infection at the site of the plate and screws. A PET scan was also obtained and was completely negative for metastasis. The patient stated that he wanted immediate removal of the plate because of the extreme level of discomfort associated with it. Decision was therefore made to remove the infected plate as per the patient’s request. Jaw reconstruction would be the next step in the rehabilitation of the patient. This would be performed utilizing reconstruction plate and bone grafts harvested from the patient. Good consolidation of the bone grafts would take a few months after surgery. This would be followed by dental implant surgery to complete rehabilitation of the patient. Artificial teeth or replacement teeth would be placed on the dental implants. Removable dentures are never opted for by patients nowadays. Meticulous planning of the surgery is done to avoid complications like open bite.[/vc_column_text][vu_heading style=”2″ heading=”Successful surgical removal of reconstruction plate and debridement of infected tissue” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]General anesthesia was induced through bronchoscopic intubation due to difficulty opening his mouth. Once the patient was anesthetized, a linear incision was placed over the exposed plate extraorally. Dissection was done up to the condylar prosthesis. The infected mandibular reconstruction plate and screws were removed along with the condylar head. Infected bone was then thoroughly debrided until healthy bone was exposed. The soft tissues surrounding the region were also cleared of infected tissue. The wound edges were then approximated and closed with sutures.[/vc_column_text][vu_heading style=”2″ heading=”Successful resolution of symptoms caused by infected reconstruction plate” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The surgery was successful and there were no postoperative complications. The patient was very happy with the outcome of the surgery. He and his family expressed understanding that this was the first step towards total rehabilitation of his oral tissues. They said that they would return in three to four months for jaw reconstruction.[/vc_column_text][vu_heading style=”2″ heading=”Surgery Video” subheading=”” alignment=”left” custom_colors=”” class=””][vc_video link=”https://youtu.be/faP7JQxyzcM”][/vc_column][/vc_row][/vc_section]
Jawline Correction Surgery Using Internal Distraction
The patient is a 26-year-old male from Kashmir in India. He had always felt that he had a weak chin since his childhood days
Prof. SM Balaji invited to Conduct Master Class in Saint Petersburg
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vc_column_text]Chennai Based Craniomaxillofacial Surgeon, Prof. Dr. S. M. Balaji of the Balaji Dental and Craniofacial Hospital is invited by the President of the International Cleft Lip and Palate Foundation (ICPF), Prof. Dr. Kenneth Salyer, President, World Craniofacial Foundation to organize a Master class at a conference in Russia. The International Cleft Lip and Palate Foundation are to organize its annual International conference at St. Petersburg, Russia in the month of July 2020. The ICPF is a world-renowned body and is a multi-disciplinary humanitarian foundation devoted to cleft lip and palate patients. It was established on October 23 1997, at KYOTO, Japan that has members from medical, surgical, speech pathologists, mental health professionals, patient care bodies, geneticists and patients from nearly 67 countries across the world.[/vc_column_text][vc_video link=”https://youtu.be/1TOuL-vwPXA”][vc_column_text]Prof. Balaji was invited by ICPF President Kenneth Salyer to demonstrate the surgical correction of midfacial hypoplasia as a part of their conference. In this course, Prof. Balaji will teach the audience on the correction of midfacial deformities, as a part of syndromes such as Apert syndrome, Crouzon syndrome, and Treacher Collins syndrome with or without cleft lip/palate. Management of skeletal Class III malocclusion in midfacial hypoplasia is one of the most challenging cases. The cause of this disorder is often multifactorial and often syndromic in nature. The appropriate diagnosis of the condition, age of presentation, the extent of deviation from normalcy dictates the treatment outcomes. There are several treatment methods for managing the skeletal Class III malocclusion with midfacial hypoplasia. Of them, conventional Lefort III advancement is often the preferred treatment. It is usually done after skeletal maturity by age after 23 years. The procedure carries the risk of a proper split during the mandible, proper plating and subsequent plating. Tooth positioning, jaw spaces are other considerations to be accounted for. The chance of relapse is high owing to muscle memory and pull. In comparison, Distraction Osteogenesis can be carried out during the early second decade of life, account for minor maxillary discrepancies, create new bone, manage the growth vectors efficiently in a controlled fashion. Active post-surgical orthodontics may be required for up to 3 months post-operatively using elastics. Prof. S. M. Balaji has about three decades of experience in managing a variety of skeletal Class III malocclusion using both Lefort III advancement and Distraction Osteogenesis. Armed with his personal cases, he is to demonstrate and teach the delegates to identify types and complications associated with Craniofacial Skeletal Class III Management, brief on the advantages and disadvantages of Lefort III advancement with Distraction Osteogenesis, help to choose between Lefort III advancement with Distraction Osteogenesis. He aims to teach the delegate to develop a personalized diagnostic and treatment algorithms for management. [/vc_column_text][/vc_column][/vc_row][/vc_section]
Dr SM Balaji represents the Academy of Dentistry International at the 3rd Global NCD Alliance Forum in Sharjah
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”The 3rd Global NCD (Noncommunicable Diseases) Alliance Forum held in Sharjah” subheading=”” alignment=”left” custom_colors=”” class=””][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_column_text]The 3rd Global NCD Alliance (NCDA) Forum was held recently in Sharjah in the United Arab Emirates. This forum was organized by the NCDA in association with the Friends of Cancer Patients (FoCP), which was the local host body. The Forum was held under the patronage of Her Royal Highness Sheikha Jawaher bint Muhammad Al-Qasimi, Founder and Patron of FoCP and wife of the ruler of Sharjah, His Highness Sultan bin Muhammad Al-Qasimi. The NCDA was formed to raise awareness about noncommunicable diseases, which are the biggest challenge facing medicine and dentistry today. Diabetes and dental caries are two global pandemics that are rampant and widespread across every strata of society. This alliance aims to bring the world’s biggest healthcare organisations under one umbrella to battle such diseases.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6631″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Dr SM Balaji as Academy of Dentistry International (ADI) representative at the forum” subheading=”” alignment=”left” custom_colors=”” class=””][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_column_text]Dr SM Balaji represented the ADI at the forum as a member of the Executive Council, ADI and Editor-in-Chief of the Journal of Global Oral Health (JGOH), which is the official publication of the ADI. The JGOH is an initiative that seeks to highlight the devastation caused by NCDs on populations and to help guide policy decisions in this regard. The SEARO(Southeast Asian Regional Office-World Health Organization) Alliance meeting was also conducted in Sharjah. Participation was robust with representatives from all member nations contributing information about ongoing development projects and plans for the future in their respective regions. Dr SM Balaji was elected as Secretary of the SEARO at this year’s meeting.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6636″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Dr SM Balaji meets with the Executive Directors of Global Organisations” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji met with Dr Christopher Fox, Executive Director, International Association for Dental Research (IADR) and Dr Enzo Bondioni, Executive Director, World Dental Federation (FDI) at the Global NCDA forum. He also met with Dr Jean-Luc Eisele, Executive Director, World Heart Federation.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6638″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6639″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][vc_column_text]Their discussions revolved around the increasing evidence linking good oral health and a healthy heart. They discussed the importance of a joint effort towards tackling the biggest health issues that faced mankind today in the form of noncommunicable diseases.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6642″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6643″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][vu_heading style=”2″ heading=”A meeting with Mr Nelson Mandela’s granddaughter at the Sharjah forum” subheading=”” alignment=”left” custom_colors=”” class=””][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_column_text]Dr SM Balaji also met Ms Zoleka Mandela, granddaughter of the legendary former South African President, Mr Nelson Mandela. He expressed his admiration for her grandfather and said that he is an inspiration to the whole world as a leader who changed the lives of millions of people. Ms Mandela is a cancer survivor and was a special invitee of the Founder and Patron of FoCP. She spoke at the forum about her battle against the dreaded disease and the obstacles that had to be overcome during that difficult period. She stressed on the need to fill in the lacunae that exist regarding awareness about the causes of cancer in the poorer regions of the world.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6644″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Dr SM Balaji visits the University of Sharjah Medical School” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji was invited to visit the medical school of the University of Sharjah. He had a lengthy interaction with the students who quizzed him about his passion for Cranio-maxillofacial Surgery. He motivated them to focus on their career while also reminding them about the service oriented nature of the profession.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6646″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_column_text]Dr SM Balaji presented them with his ‘Textbook of Oral and Maxillofacial Surgery,’ which was greatly appreciated by the students.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Bilateral Jaw Condyle and symphysis Fracture Surgery
Patient suffers injuries from a two wheeler road traffic accident The patient is a 23-year-old male from Cuttack in Odisha, India, who rides a two-wheeler to work. It was on the way to work that he was involved in a multiple vehicle road traffic accident. He had fallen down with his chin directly impacting on the asphalt surface. There was also a skin laceration with bleeding at the point of impact on his chin. He had immediately developed excruciating pain to his jaw region along with inability to open his mouth. An ambulance had been summoned to the accident spot and the patient had been rushed to a nearby hospital. First aid had been administered to his wounds and the chin and lip lacerations had been sutured. His wounds had also been thoroughly debrided. Diagnosis of multiple fractures to the lower jaw from the accident The patient had been informed that there were multiple fractures to his lower jaw. Upon hearing this, the patient had requested that he wanted to get this treated at our hospital and had been discharged. The patient and his parents then emergently flew down to Chennai to get this treated at our hospital. Our hospital is renowned for facial fracture surgery in India. Patients with multiple fractures to the face resulting from road traffic accidents have been successfully rehabilitated at our hospital. Successful facial reconstruction surgery arising from shattered facial bones is a specialty feature at our hospital. Initial presentation at our hospital for treatment of his fractures Dr SM Balaji, facial trauma surgeon, examined the patient and obtained a detailed history from his parents. They reported that the patient complained of extreme pain when opening and closing the mouth. Eating and speech had also been very difficult since the accident. He also had an open bite following the accident. Radiological studies including an OPG and a 3D CT scan were then ordered. These revealed that the patient had a displaced symphysis fracture. There were also displaced right and left condylar fractures and a left coronoid fracture. The bilateral condyle fractures were displaced medially. There was no damage to the stylomastoid foramen. The internal acoustic meatus was also intact with no compromise in hearing. Only complicated presentation of the fractures was the medial displacement of the condyles. Treatment planning formulated and explained to the patient in detail The severity of the fractures was explained to the patient and his parents in detail. They were advised that he needed immediate symphysis and left condylar fracture reduction and fixation. It was explained to them that intermaxillary fixation would also be necessary to promote healing. The patient was also advised to stay on a liquid diet for about two to three weeks following surgery. This would need to be followed by another ten days on a semisolid diet. The patient and his parents expressed understanding of the treatment plan and consented to surgery. Successful surgical reduction of the multiple mandibular fractures Under general anesthesia, the previously placed sutures in the chin and lip were removed. This was followed by a sulcular incision in the mandible. A mucoperiosteal flap was then elevated. The symphysis fracture identified, reduced and then fixed using two four-holed titanium plates and screws. Attention was next turned to the condylar fractures. An open bite is always a presentation in cases of bilateral condylar fractures. It is necessary at times to perform open reduction and internal fixation of both condyles to correct the open bite. However, in this case, it was deemed that unilateral left-sided reduction would rectify the patient’s open bite. A modified Alkayat Bramley incision was placed on the left side of the face. A flap was then elevated to expose the site of the condylar fracture. The condylar fracture was reduced and adequate correction was demonstrated through movement of the mandible. Once occlusion had been confirmed to be normal, the fracture segments were then fixed using titanium plates and screws. Extreme care was taken throughout the surgery to ensure that there was no damage to the facial nerve. This was followed by sutures to the chin and lip lacerations. Total restoration of normalcy with normal facial nerve function There was complete restoration of normal occlusion following surgery. Postsurgical facial nerve testing revealed normal facial nerve function. The patient was very happy following successful completion of surgery. He related that there was full restoration of facial esthetics following surgery. It was explained to him that he had to carefully follow all postoperative instructions. He said that he would follow the dietary restrictions that had been previously explained to him. Surgery Video
Dr SM Balaji invited as Chief Guest at the 7th STAR Summit at Saveetha Dental College
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vc_column_text]The 7th Saveetha Transdisciplinary Annual Research (STAR) Summit recently concluded at Saveetha Dental College in Chennai. Dr SM Balaji, Director, Balaji Dental and Craniofacial Hospital, was invited as a Guest of Honour at the grand annual event that showcases the best of student research.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6616″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6617″ img_size=”full”][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Excellence in surgical research over a period of 25+ years” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This was in recognition of Dr SM Balaji’s high achievements and accomplishments in the field of surgical research pertaining to the field of Oral and Cranio-Maxillofacial Surgery. His innovations in surgical flap design for cleft lip and palatal surgery have enabled faster rehabilitation for children afflicted with this facial deformity.[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6618″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6619″ img_size=”full”][/vc_column_inner][/vc_row_inner][vc_column_text]Dr Sheeja Varghese, Dean, Saveetha Dental College, warmly welcomed Dr SM Balaji to the summit. Dr SM Balaji addressed the audience after the traditional lighting of the lamp ceremony.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Motivating the next generation for a full time career in dental research” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]He spoke to the audience of researchers and postgraduate students about his journey as a surgeon in a limited resource setting nation. Explaining how constant innovations help improve the various parameters of surgical outcome, he spoke to them about the difficulties associated with research. He spoke to them about the grit, determination and hard work that are the basic qualities needed for sustaining oneself in research.[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6621″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6622″ img_size=”full”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”2/3″][vc_column_text]His talk was followed by a lively Question and Answer session with the audience where the audience quizzed him on a variety of research related topics. Dr SM Balaji patiently devoted quality time to answering these queries raised by the next generation of researchers.[/vc_column_text][vc_column_text]The organizers and the students expressed their gratitude to Dr SM Balaji for the valuable insight he provided regarding research as a full time career in India.[/vc_column_text][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6623″ img_size=”full”][/vc_column][/vc_row][/vc_section]
Jaw Reconstruction, Distraction Osteogenesis and Dental Implant Surgery
Patient develops lower jaw swelling about a year ago The patient is a 24-year-old male from Hoskote in Karnataka, India. He developed a swelling in the region of the left lower jaw around a year ago. This was especially alarming since he has always had asymmetry of the face with deviation of the mandible to the left side. The swelling was also associated with pain and subsequent tooth mobility in the involved region. This had been followed by a visit to a local dental clinic where radiographic imaging had been obtained. A provisional diagnosis of odontogenic keratocyst had been made by the specialist there. It was explained to the patient that he needed to undergo left-sided partial mandibulectomy to resect the lesion. This would need to be followed by reconstruction of the jaw. He had subsequently undergone surgery at a nearby city. The lesion had been resected, but unfortunately the condyle had been displaced superiorly into the region of the lateral pterygoid. This had resulted in worsening asymmetry of his face. The patient had become extremely distressed by this turn of events. His parents had presented to the operating surgeon for a solution to his problem. Realizing the enormity of the condylar surgical correction and reconstruction required by the patient, the patient had been referred to our hospital for treatment. What is an odontogenic keratocyst and how is it managed? An odontogenic keratocyst is benign developmental cyst that is locally aggressive. Peak incidence is mostly during the second or third decades of life. At least 50% of odontogenic keratocysts are found in the posterior body and lower ramus of the mandible. Segmental mandibulectomy is performed, but results in gross residual deformities of the face. Swelling is the most common presenting complaint. They may also be asymptomatic and found incidentally on dental radiographs. Plastic reconstructive surgery is necessary to full rehabilitate the patient. Usage of distraction devices helps restore facial symmetry. Implant treatment enables replacement of lost teeth. Initial presentation at our hospital for treatment of his odontogenic keratocyst Dr SM Balaji, jaw reconstruction surgeon, had examined the patient and obtained comprehensive imaging studies including a 3D CT scan. The 3D CT confirmed that the condyle had been superiorly displaced into the region of the lateral pterygoid muscle. He explained to the patient that he needed reconstruction of his resected jaw through bone grafts harvested from the patient. He further explained that the patient’s idiopathic facial asymmetry could also be corrected through mandibular internal distractor surgery. A detailed explanation of the treatment process was given to the patient. Realizing that corrective jaw surgery would result in complete resolution of his facial asymmetry, the patient happily consented to undergo this surgery. Successful mandibulectomy and internal distractor placement surgery Under general anesthesia, the condyle was first brought back into correct anatomical position. This was followed by reconstruction of the resected mandible using the bone grafts. The bone grafts were fixed in position using titanium screws. He also underwent placement of a left mandibular ramus distractor. A latency period of one week was allowed following placement of distractor. The distractor was subsequently activated by 1 mm each day for 18 days. This achieved an increase of 18 mm of mandibular distraction on the left side. The time frame was explained to the family before surgery. It was explained that six months would be required for full consolidation of the new bone. He was instructed to return in six months. Distractor device would be removed and implants would be placed at that point. The patient expressed understanding of the instructions. Patient returns for distractor removal surgery and dental implant surgery A 3D CT scan was obtained at the site of distraction to check for bone consolidation. There was also good consolidation of the bone grafts at the site of the jaw reconstruction surgery. This was explained to the patient and he was scheduled for distractor removal and implant placement. Removal of mandibular distractor and placement of dental implants Under general anesthesia, an incision was placed in the left posterior region at the region of the distractor. A flap was then raised followed by removal of the left mandibular ramus distractor. Nobel Biocare dental implants were then placed in relation to the left mandibular second premolar and second molar. Hemostasis was achieved and wound closure was done using resorbable sutures. Successful outcome of surgery with complete patient satisfaction Complete symmetry of the patient’s face had been established through the distraction. The patient was extremely happy that he now had good facial harmony. He expressed how this would result in greatly increased social acceptance amongst peers. It was explained to him that he needed to return in three to four months for placement of ceramic crowns on the dental implants. The patient expressed complete understanding of the instructions and expressed his happiness before discharge from the hospital. Surgery Video
Jaw Reconstruction Surgery after Ameloblastoma Removal
Patient dissatisfied with results of previous jaw reconstruction surgery The patient is a 33-year-old patient from Indore in Madhya Pradesh, India. He had been diagnosed with ameloblastoma around four years ago. Surgery had been advised for him and he had then undergone ameloblastoma mandibular resection. This had been followed by mandibular reconstruction with a titanium plate and screws. The surgery had been performed at a nearby city. Bone grafts had been used to rebuild the mandibular bone. The patient however was not happy with the results of the surgery. He mentioned that his jaw bone seemed to be very deficient and implants could not be placed. Eating and speech have been difficult since this surgery. This had caused a compromise in the quality of daily living and he had wanted to get this addressed. Patient referred to our hospital for surgery by many specialists The patient had made enquiries regarding the best hospital to undergo jaw reconstructive surgery. He had been referred to our hospital by multiple sources. Our hospital is a renowned center for jaw reconstruction and other complex surgeries. We also perform dentigerous cyst surgery, odontogenic keratocyst surgery, hemifacial microsomia surgery, etc. Large cysts are enucleated followed by jaw reconstruction at our hospital. Ear reconstruction for microtia is a specialty surgery performed in our hospital. Orthognathic surgery for jaw size discrepancies has rehabilitated scores of patients. Dental implant surgery followed by placement of artificial teeth is done using Nobel Biocare implants and Zirconium/ceramic crowns. Remodeling of gum tissue through laser gum surgery offers good esthetic and functional results at our hospital. All this is enabled through the application of the latest state of art technology. He presented with a complaint of a mandibular defect. The patient mentioned that his jaw was very thin and that he was unable to bite or chew on foods properly. He wanted to correct his jaw and replace his teeth as soon as possible. Initial presentation at our hospital for mandibular reconstructive surgery Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained a detailed history. He then ordered for radiological studies including a 3D CT scan. This revealed that the patient had deficient bone at the site of the mandibular reconstruction plate. The anterior mandibular bone was very thin and insufficient to support placement of implants. Occurrence of ameloblastoma and treatment modalities Ameloblastoma is a rare, benign or cancerous tumor of the odontogenic epithelium, which are more common in the mandible. This was initially known as adamantinoma and was renamed in 1930 by Ivey and Churchill. They are rarely malignant or metastatic, but can lead to severe disfigurement due to gradual growth. Surrounding healthy bone is also destroyed by this lesion. Hence, a wide surgical excision of surrounding tissues is required to treat this disorder. If left untreated, it could potentially obstruct nasal and oral airways making it impossible to breathe without oropharyngeal intervention. Formulation of treatment and jaw reconstructive surgery It was explained to the patient that rib grafts needed to be harvested to reconstruct the bony defect in his mandible. Dental implant surgery would be performed after consolidation of the grafts with the mandibular bone. The patient was in complete agreement with this treatment plan and consented to surgery. Under general anesthesia, a right inframammary incision was made and a costochondral rib graft was harvested. This was followed by a midcrestal incision placed in the anterior mandible. A flap was then elevated and dissection was made down to the site of mandibular resection. The previously placed mandibular reconstruction plate and screws were removed. Segments of the bone graft were then crafted to recreate good mandibular form. The mandible was then reconstructed using the shaped rib graft and titanium screws. Hemostasis was then achieved and closure of the incision was done with sutures. Successful reconstruction of the deficient mandibular bone There was good recreation of mandibular form after surgery. The mandible had been reconstructed to its previous dimensions. The surgery was successful with no complications. Patient recovered completely following surgery. It was explained to the patient that implants would be placed after consolidation of the grafts. He was instructed to return in 3-4 months for placement of dental implants. Surgery Video