Palatal fistula closure Pharyngoplasty – Positive Suction Test
Patient with air escaping through nose during speech The patient is a 13-year-old female from Kallakurichi in Tamil Nadu, India. She was born with a bilateral cleft lip and palate deformity. Her parents had been counseled extensively regarding the correct surgical schedule for corrective surgery. They had meticulously followed the instructions provided at the time of her birth. She had first undergone cleft lip surgery at three months followed by cleft palate surgery at nine months. Cleft alveolus surgery had been performed at 3-1/2 years of age. Results from the surgery were however suboptimal. There was upper lip deformity and she had feeding and speech difficulties. She had undergone three further surgeries to correct her problem, but none of the surgeries were successful. The patient has always had difficulty with pronunciation of certain words. This made it difficult for people to understand her speech. Teachers had always complained to her parents that it was difficult comprehending her. There had always been a nasal quality to her speech. Difficulty with employment due to her speech impairment The patient is from a disadvantaged background and has been facing significant bullying at school. Her peers made fun of her speech difficulties. She has always been good at her academics. However, this bullying had become very frustrating for her and her parents had taken her a local hospital regarding this. The doctor at the hospital had examined her and diagnosed her to have velopharyngeal insufficiency. This was causing air to escape through her nose when vocalizing sounds like ‘ah.’ Her speech was getting distorted and acquiring a nasal quality because of this. He had referred her to our hospital for corrective surgery. Initial presentation at our hospital for corrective surgery Dr SM Balaji, speech correction surgeon and pharyngoplasty specialist, examined the patient and obtained a detailed history. The patient had a palatal fistula. There was also a gross insufficiency of the soft palate, which resulted in air escaping through the nose during speech. He then referred the patient to a speech pathologist for a speech assessment test. This confirmed his diagnosis of velopharyngeal insufficiency. Plastic surgeons in the United States of America first formulated a surgical protocol for successful treatment of velopharyngeal insufficiency. This is rigorously followed in our hospital. Intonation of certain sounds results in the palate rising and touching the back of the throat. This pushes air forward and out of the mouth. The soft palate does not contact the throat during speech in velopharyngeal insufficiency. This causes air to escape through their nose during speech. Treatment planning formulated and explained to the patient and parents The patient was advised that the palatal fistula had to be closed. It was also explained that she needed a sphincter pharyngoplasty with double layer closure. This would result in correction of velopharyngeal insufficiency. There would be no necessity for bone grafts in speech correction surgery. It was decided to perform both procedures in a single operation to reduce the financial burden for the patient. The patient and her parents were in agreement with the treatment plan and consented to surgery. Her parents also give a history of recurrent ear infections when she was an infant. Successful surgical correction of velopharyngeal insufficiency Under general anesthesia, the patient underwent palatal fistula closure using the Veau-Wardill Kilner technique. This was followed by the sphincter pharyngoplasty, which was performed by taking flaps of tissue from just behind the tonsil on each side. These flaps were then connected together across the back of the throat, thus narrowing the throat opening. A small, central opening or “dynamic sphincter” was retained in the middle for breathing through the nose. A suction test was performed at the end of the procedure. This demonstrated good movement of the soft palate thus indicating optimum results from the surgery. A positive suction test showed movement of the roof of the mouth. This is indicative of good surgical results. Total patient satisfaction from the results of the surgery The patient’s speech was much improved from previous to surgery. She and her parents expressed their happiness at the results of the surgery. They were however instructed that she would need to undergo speech therapy for her speech to normalize completely. The patient will be referred to a speech therapist for further management. Surgery Video
National Brainstorming Meeting on Advancing Dental Research In India
[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=”” width=”1/2″][vc_column_text]Dr SM Balaji was invited by Dr OP Kharbanda (CDER, AIIMS, New Delhi) to the Centre for Dental Education and Research (CDER) at the All India Institute of Medical Sciences, New Delhi (AIIMS) recently for the National Brainstorming Meeting on Advancing Dental Research in India.[/vc_column_text][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6579″ img_size=”full”][/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=””][vc_column_text]Dr SM Balaji (Science Information Committee, IADR and Secretary General, ISDR) is a core member of the International Association for Dental Research-Regional Development Program (IADR-RDP) project committee. Dental Research is a rapidly developing aspect of dentistry in India today and there are many centers that have devoted significant resources towards this.[/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=”6581″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6582″ img_size=”full”][/vc_column_inner][/vc_row_inner][vc_column_text]The IADR-RDP was established with the aim of providing research grants to pioneering studies that would help expand the horizons of known knowledge and advance current scientific knowledge. The core members of this project committee analyze the research submissions for potential future implications and beneficial applications.[/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=”Recognition of contributions to dental research by Dr SM Balaji” subheading=”” alignment=”left” custom_colors=”” class=””][/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=”6584″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6585″ img_size=”full”][/vc_column_inner][/vc_row_inner][vu_heading style=”2″ heading=”Guest of Honour and Chief Guest at the Brainstorming meeting” 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 Randeep Guleria, Director, AIIMS, New Delhi and Lt Gen Sanjay Londhe, Director General, Dental Services, Army Dental Corps, Special Invitees, spoke about their experiences with medical and dental research in the country. Dr Ritu Duggal, CDER, AIIMS, formally welcomed the Director General to the meeting. The meeting was formally inaugurated with the ceremonial lighting of the lamp by the invited dignitaries.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6586″ 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=””][vu_heading style=”2″ heading=”Impetus towards fostering greater growth of research opportunities in India” 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]Also invited to the gathering were key opinion leaders who are heading key research projects in the country. Dr SM Balaji addressed the gathering, speaking at length about research opportunities in the country and how to best utilize time and budgetary constraints in the most resourceful manner.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6587″ 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=””][vu_heading style=”2″ heading=”Key resolutions adopted during the course of the meeting” 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]Intense discussions were held over the course of the day and important resolutions were tabled towards the advancement of dental research. Pros and cons of choosing a career in research in India were explained by full time researchers present at the meeting. Ways to motivate more professionals towards choosing a fulltime career in research was delved into at depth. The meeting was a resounding success with unanimous acceptance of the resolutions passed. Further annual meetings have been planned under the auspices of IADR and CDER, AIIMS, New Delhi.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6588″ img_size=”full”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Zygoma Fracture Surgery – Open Reduction and Plate Fixation
Patient sustains a facial injury from a two wheeler accident The patient is a 36-year-old male from Madurantakam in Tamil Nadu, India. He was on his way to work on his two-wheeler when he hit a coconut lying on the road. This caused him to skid and lose balance. He fell down on the right side of his face on a grassy area by the roadside. There was direct impact on the cheek region. Passersby immediately rushed him to a nearby hospital where x-rays were taken. The patient was diagnosed with a right zygoma fracture by the duty doctor there. He had then been referred to our hospital for surgical management of his facial fracture. He was not wearing a helmet at the time of the accident. It was explained to the patient that wearing a full face helmet would have prevented the fracture. Occurrence of zygomatic fracture and associated symptomatology Zygoma fracture is a form of facial fracture caused by a fracture to the zygomatic bone. This often results from facial trauma such as violence, falls or automobile accidents. Symptoms include flattening of the face, trismus (reduced opening of the jaw) and subconjunctival hemorrhage. It has been scientifically proven through the use of crash test dummies that helmets prevent facial and head injuries. Statistics prove that 99% of head injuries occur in riders without helmets. It is a laudable initiative by the government to educate the public towards road safety awareness through the use of helmets. There is scientific evidence that the chances of the pillion rider suffering fatal injuries are very high. It is therefore imperative that the pillion rider too wears a helmet. Initial presentation at our hospital for treatment Dr SM Balaji, facial trauma surgeon, examined the patient and obtained a detailed history. The patient complained of a depression on the right side of the face along with pain, swelling and limitation of function. He stated that he was very upset by the facial asymmetry that had been caused by the accident. A complete clinical and radiological evaluation was done. Clinical examination revealed a depressed right zygoma. Radiographic examination revealed depressed right zygoma, zygomatic arch and frontozygomatic fracture. This is the classical fracture pattern caused by impact in the zygomatic region from road traffic accidents. The findings were explained to the patient in detail. He was advised to undergo zygoma fracture reduction and fixation through an intraoral approach. This would avoid any unsightly extraoral scarring. The patient was also advised to take liquid diet for about 1-2 weeks followed by a semi-solid diet. Successful rehabilitation of the fracture and return to normalcy Under general anesthesia, a sulcular incision was made in the right maxillary vestibular region and a flap was raised. Dissection was made to the region of the zygomatic fracture. The depressed right zygoma fracture segment was identified, reduced and stabilized using titanium plates and screws. The closure was done using resorbable sutures intraorally. Surgery was successful with no postoperative complications. Results were immediate. The patient was greatly satisfied with the outcome of the surgery. There was no residual facial depression and his face was now symmetrical on both sides. He expressed his happiness to the surgical team. Surgery Video
Dr SM Balaji meets His Excellency Biplab Kumar Deb, Chief Minister of Tripura
[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=”Dr SM Balaji invited to the 19th Annual Dental Conference, IDA, Tripura” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The 19th Annual Dental Conference of the Tripura State Branch of the Indian Dental Association (IDA) was recently held in Agartala, Tripura. The Hon’ble Chief Minister of Tripura, His Excellency Biplab Kumar Deb was the Chief Guest at the conference.[/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=”6559″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6560″ 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=””][vc_column_text]Dr SM Balaji, renowned Cranio-Maxillofacial Surgeon from Chennai was invited as a guest of honour by Dr Manik Saha, Congress President and DCI member, in light of his contributions towards the advancement of dentistry in India. He was also invited to deliver the keynote lecture at the conference in recognition of his achievements in the field of Cranio-Maxillofacial Surgery. The topic chosen by him was “Advanced Oral Surgery in Dental Practice.”[/vc_column_text][vu_heading style=”2″ heading=”Inauguration of the conference by the Hon’ble chief minister of Tripura” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The conference commenced with the ceremonial lighting of the lamp by His Excellency Biplab Kumar Deb and Dr SM Balaji. The Chief Minister addressed the audience, speaking about the role played by dentists towards improving the overall wellness levels in society. He also spoke about addressing the need to improve awareness about oral health in the community, which would in turn lead to greater holistic advancement of society.[/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=”6561″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6562″ 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=”Guidance towards improving the delivery of oral healthcare” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The Chief Minister and Dr SM Balaji held discussions along the sidelines of the conference regarding how advances in dental sciences could be integrated into the health departments of the states. Dr SM Balaji related from his personal experience about the ways of implementing improvements into the existing healthcare system.[/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=”6563″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6564″ 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=””][vu_heading style=”2″ heading=”Keynote lecture on the implementing advances in the clinical setting” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji’s keynote lecture was a highlight of the conference. He spoke about the role of research related advances in oral surgery that had practical applications in the treatment of oral diseases on an everyday basis in the dental clinic. Explaining further, he related how overall postoperative morbidity could be greatly reduced by adopting the latest advances in surgery into everyday dental clinic procedures.[/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=”6565″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6566″ img_size=”full”][/vc_column_inner][/vc_row_inner][vc_column_text]The Question and Answer session was a prolonged affair with members of the audience benefitting from the answers provided by Dr SM Balaji from his 25+ years experience as an oral surgeon. Members of the audience expressed their appreciation at the way he patiently took the time to address each query that was addressed to him.[/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=”6567″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6568″ img_size=”full”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Pharyngoplasty – Speech Correction with Positive Suction Test
Patient born with cleft lip and palate deformity The patient is a 29-year-old male from Theni in Tamil Nadu, India. He is a known case of cleft lip and palate deformity who had been born in Madurai. His parents had been counseled regarding what to expect with an infant with cleft lip and palate deformity. Surgery performed as per correct surgical protocol for cleft deformity He had undergone cleft lip surgery at three months of age and cleft palate surgery at nine months of age at a hospital in Madurai. This had been followed by cleft alveolus surgery at the age of 3-1/2 years. These surgeries had resulted in good restoration of function and esthetics for the patient. He had not faced any feeding problems after his surgery. All his growth parameters had been met on schedule and the patient had thrived well. He had always been good at academics and is now well settled in life. Persistent difficulty with speech for forming certain sounds He has however had persistent difficulty with speech. There had always been a hypernasal speech quality with difficulty associated with pronouncing certain sounds. Some of his colleagues at work had found it difficult to understand his speech. This is due to velopharyngeal dysfunction. His difficulty with speech had been diagnosed to be due to a palatal fistula. This fistula was causing air to escape into the nose during speech. His parents stated that his voice was not clear while pronouncing certain words. There was a clear nasal quality to his voice. His parents mentioned that they were also looking for a bride to get him married and wanted to correct his speech problem as soon as possible. The patient wanted to undergo speech correction surgery. Initial presentation at our hospital for correction of his speech problems Dr SM Balaji, pharyngoplasty specialist, examined the patient and ordered for radiological studies. He further referred the patient for a speech assessment, which stated that the patient’s nasal twang was caused by velopharyngeal insufficiency (VPI). Velopharyngeal insufficiency and its implications on daily life Velo refers to the velum or soft palate. It is the part of the roof of the mouth that moves with sounds like “ah.” Pharyngeal refers to the throat. During normal speech with the creation of certain sounds, the palate rises to touch the back of the throat and sends the air out of the mouth. In the case of a child with velopharyngeal insufficiency, there is deficiency in the posterior extent of the soft palate. This results in the soft palate not contacting the throat during the creation of sounds like “ah.” This results in air escaping through the nose during speech instead of exiting through the oral cavity, thus rendering a nasal quality to the speech. Treatment planning formulated for the patient It was decided to perform a Veau-Wardill Kilner sphincter pharyngoplasty for the patient. This would involve taking flaps of tissue from just behind the tonsil from each side. These flaps of tissue are then connected across the back of the throat. This results in narrowing down of the throat opening. A small central opening or “port” is left in the middle for breathing through the nose. Successful surgical correction of velopharyngeal insufficiency Under general anesthesia, the patient underwent a sphincter pharyngoplasty with creation of the small central “port” to facilitate proper nasal breathing. A suction test performed at the end of the surgery resulted in proper action of the soft palate. This indicated complete correction of the velopharyngeal insufficiency. There was improvement in the tone of voice after surgery. The patient and his family were very happy with the results of the surgery. It was explained to them that he would need speech therapy to completely normalize the quality of his voice. They expressed understanding of the instructions and said that this would definitely lead to an improvement in the quality of life for the patient. Surgery Video
Cosmetic lip reduction surgery with hemangioma removal
Patient with increasing lip deformity over the last ten years The patient is a 33-year-old female from Hubli in Karnataka, India. She stated that she had been fine up until about 10 years ago. It was around that time that her lower lip began to gradually increase in size. This continued to grow in size until it became large enough to prevent closure of her mouth with loss of lip seal. Eating and speech also became difficult due to this. There was also significant facial cosmetic deformity because of her lower lip deformity. She approached a local cosmetic surgeon around six years ago. He had examined her and had diagnosed it as a vascular lesion (hemangioma). His recommendation was for lip reduction surgery to reduce the lip back to its original anatomical dimensions. Surgery had been performed with reduction in the size of the lip. The lip however continued to grow and was back to its increased size within two years after surgery. She had undergone another surgery at that point, which also proved to be of no avail in providing her with a permanent solution. In addition, she felt that the second surgery had caused a deformity to the shape of her lip. The patient began to feel hopeless and depressed by the situation. Feeling very frustrated, she and her husband had made enquiries regarding the best hospital to undergo cosmetic lip surgery. They had subsequently been referred to our hospital. Our hospital is a leading center for various facial reconstructive surgeries. Initial presentation at our hospital for surgical correction of her lip deformity Dr SM Balaji, cheiloplasty specialist, examined the patient and obtained a detailed oral history. Suspecting it to be a hemangioma of the lower lip, he then ordered an angiogram to confirm his diagnosis. The angiogram confirmed his initial diagnosis of hemangioma. He explained to the patient and her husband that he planned to perform lip reduction surgery along with cauterization of the feeder vessels. Diathermy would be used to perform this. This would result in permanent resolution of the patient’s problems. They were in agreement with the treatment plan and consented to undergo surgery. What is hemangioma and how is it treated? Hemangioma is a benign vascular tumor derived from blood vessel cell types. The most common form is the congenital infantile hemangioma, commonly referred to as a strawberry mark. This is most commonly seen on the skin at birth or in the first few weeks of life. A hemangioma can occur anywhere on the body, but most commonly appears on the face, scalp, chest or back. Treatment of hemangioma is usually unnecessary unless it interferes with vision or breathing, or in rare cases, internal hemangioma causes or contributes to other medical problems. It is also addressed when it leads to a cosmetic disfigurement for the patient. Hemangioma is usually treated by surgery or by injecting sclerosing agents into its feeder vessels. Successful surgical reduction and contouring of enlarged lower lip Under general anesthesia, the lip hemangioma was excised in its entirety. Diathermy was used to make the incision and cauterize the feeder vessels to the hemangioma. Once proper lip form and contour had been established, hemostasis was achieved and the incision was sutured with resorbable sutures. The patient was very happy with the outcome of the surgery. She was now able to close her mouth with ease and had a symmetrical lower lip. The size and form of her lip was now in complete harmony with the rest of her face. She was also very happy that there was no visible scarring from the surgery. Surgery Video
Bilateral Microtia Recorrection with Costal Cartilage Graft
Patient born with external ear deformity The patient is a 13-year-old boy from Chittoor in Andhra Pradesh, India. He had been born without external ears. There were only rudimentary structures present at the site of bilateral ears. He had been diagnosed with hemifacial microsomia with bilateral microtia. There was also gross asymmetry of his face. The patient had faced constant bullying over the years in school. He had very few friends and had slowly grown depressed about the appearance of his face. Approximately a year ago, he had refused to go to school until his ear deformity had been corrected. He stated that he wanted big prominent ears. His parents had approached a cosmetic surgeon in a nearby city who had examined the patient. He had weighed all treatment options. Realizing that the patient needed microtia correction surgery, he had presented the treatment plan to the parents. They had consented to the surgery. He had been admitted to the hospital and had subsequently undergone surgery. However, the patient and his parents were not satisfied with the results of the surgery. There had been slight asymmetry of the cartilaginous form of the external ears. There were also hypertrophic scars, which were unsightly. They felt that the scar tissue needed to be addressed. It however did not involve a large area of skin. Realizing that this needed to be corrected, parents had made wide enquiries regarding the best hospital to get the problem addressed. They had subsequently been referred to our hospital for his correction surgery. Our hospital is a renowned center for facial cosmetic surgery in India. Cosmetic correction of deformities involving both bone and soft tissues are addressed at our hospital. Facial asymmetry correction surgery is a specialty at our hospital. Jaw deformity correction, ear deformity correction, scar revision surgery, cosmetic rhinoplasty and cleft deformity correction surgery are routinely performed here. Initial presentation at our hospital for treatment Dr SM Balaji, microtia correction surgeon, examined the patient and obtained a detailed history. The patient’s parents explained their anxieties and fears regarding the failed surgery. A complete clinical examination was performed and comprehensive radiographic studies including a 3D CT were ordered. It was determined that there was deficiency of cartilage that had been placed in the first surgery. The patient and his parents were reassured and counseled extensively. His 3D CT scan revealed the presence of an anatomically patent, middle ear, inner ear and ear canal. Clinical examination also revealed facial asymmetry on the left side. Auditory testing was also performed for the patient. This revealed that he had about 70-80% hearing in both the ears despite the absence of external ear structures A brief introduction to microtia and its etiological factors Microtia is a congenital deformity where the pinna is underdeveloped. Complete absence of the external ear is referred to as anotia. Because microtia and anotia have the same origin, the complex can be referred to as microtia-anotia. Microtia can be either unilateral or bilateral. It occurs approximately in 1 out of every 8000–10000 live births. The right ear is more commonly affected in cases of unilateral microtia. Microtia may occur as a complication of taking Accutane (isotretinoin) during pregnancy. The etiology of microtia in children however remains uncertain. It is suspected to be genetic in origin along with being a complication of gestational diabetes. Risk factors also include very low birth weight. Treatment planning explained to the patient and his parents in detail It was planned to correct the asymmetrical form of bilateral ears from the previous surgery. This would be followed by a subsequent stage at a later date where the ear structures would be elevated followed by creation of the ear lobule in the final stage of the surgery. They were in agreement with the treatment plan and the patient was scheduled for surgery. Harvesting of rib graft and placement at the site of bilateral ear deformity Under general anesthesia, a left inframammary incision was made and dissection was performed down to the ribs. Costochondral grafts were harvested and Valsalva maneuver was performed to ensure that there was no perforation into the thoracic cavity. The wound was then closed in layers with sutures. This was followed by incisions performed over the asymmetrically constructed ear structures. The costochondral grafts were shaped and tunneled to ensure that the resultant ear form was symmetrical and esthetically pleasing. Incisions were then sutured using nonresorbable sutures. Parents express their satisfaction with the cartilaginous ear framework The patient and his parents were very happy with the esthetic outcome of the corrective surgery. There was a well defined and symmetrical cartilaginous framework to the ears bilaterally. They could clearly visualize the ear taking shape. Parents expressed that the patient had definitely cheered up following the surgery. They stated that he was looking forward to the subsequent stage of the surgery. The ear elevation surgery using skin graft will be performed after about 6 months. Surgery Video
Thin upper lip correction – Cosmetic Lip Surgery
Patient born with cleft lip and palate deformity The patient is a 29-year-old patient from Theni in Tamil Nadu, India. He was born with a cleft lip, palate and alveolus deformity. His parents had been advised of the correct time schedule for surgical correction of his deformities. The birth had been uneventful and without any complications. As advised at the time of his birth, he had undergone cleft lip surgery at 3 months and cleft palate surgery at 9 months. Alveolar cleft surgery had been performed at 3-1/2 years. All surgeries had been performed elsewhere. He had subsequently developed acceptable feeding and speech patterns with acceptable esthetics. Increasing degree of facial deformity with the passage of time As he grew older, the degree of facial deformity gradually increased. He had been bullied a bit while in school and in college. The deformity had been bothering him a lot lately and he discussed this with his parents. They then decided to get it surgically corrected. He had made extensive enquiries and had been referred to our hospital by multiple sources. Our hospital is a specialty center for facial deformity surgery. Many patients who are dissatisfied with their appearance have undergone facial cosmetic surgery at our hospital. International recognition of our hospital by premier organisations We are a recognized referral center for the Japan-based International Cleft Lip and Palate Foundation (ICPF). The US-based World Craniofacial Foundation (WCF) has also named us as its affiliate in the Southeast Asian region. Initial presentation at our hospital for lip deformity surgery Dr SM Balaji, lip reconstruction surgeon, examined the patient and obtained a detailed history. The patient complained of a deformed upper lip and he felt that it was also very thin and asymmetrical. The patient also stated that speech and word formation was always difficult due to the lack of bulk in his upper lip. He desired to have a full upper lip that was in harmony with the rest of his face. Treatment planning formulated for correction of thin lip deformity A complete clinical and radiological evaluation was performed on the patient. It was decided to harvest a strip of fascia lata tissue from the patient’s thigh to augment the thin lip. The treatment planning was explained to the patient in detail. All his doubts regarding the surgical procedure were answered to his satisfaction. The patient then consented for surgery and was scheduled for reconstruction of his thin lip deformity. Successful surgical reconstruction of his thin upper lip Under general anesthesia, two linear vertical incisions were first placed over the lateral aspect of the right thigh. Dissection was then done up to the vastus lateralis muscle and the fascia lata was identified. A strip of fascia lata was then separated from the muscle and harvested. The incisions were then closed using sutures. Incisions were then made over the previous surgical scars in the upper lip. Tunneling was done up to the commissures of the upper lip bilaterally. The thin lip was then augmented using the fascia lata graft. The incisions were then sutured using nonresorbable sutures. Complete patient satisfaction with results of surgery There was excellent esthetic result from the lip reconstruction surgery. The degree of upper lip fullness from the surgery was in perfect harmony with the rest of his face. He said that he was very happy with the result of the surgery. His parents were also very happy with the result of the surgery. They mentioned that this will help him regain his self confidence. The patient also expressed complete satisfaction before final discharge from the hospital. Surgery Video
Closed Rhinoplasty – Nasal Deformity Correction Surgery
Broad nose deformity as chief complaint The patient had always felt that the bridge of his nose was depressed and that his nose was broad. The patient had been born with a left sided cleft lip and palate deformity. His parents had been advised of the right time schedule for him to undergo cleft lip and palate repair. He had subsequently undergone cleft lip and palate surgery in his home state of Kerala, India when he was three months and eight months old respectively. This had resulted in significant improvement in esthetics and function. He had been able to feed well and his BMI had always been within normal limits for age. However, children with this deformity tend to have exacerbation of the defect as they grow up. Facial morphology changes rapidly with growth and any residual bony defect from the cleft palate gets amplified. Depressed and lacking self confidence because of the nasal deformity He is now 24 years old and quite depressed about the appearance of his nose. The bridge of his nose was depressed leading to the nose appearing excessively broad for his face. The patient was worried that his nose was looking very big and ugly. The nose was also depressed on the left side. He has a typical cleft lip nasal deformity now. Because of the above factors, the patient desired to get his facial deformities corrected. He and his parents had made widespread enquiries regarding the best cleft rhinoplasty hospital in India. They had subsequently decided to come to our hospital for his nasal deformity surgery. Plastic surgeons and oral and maxillofacial surgeons perform cosmetic rhinoplasty. Initial presentation at our hospital for his corrective surgery Dr SM Balaji, cleft rhinoplasty surgeon, examined the patient. The left side of his nose was depressed because of his cleft lip and palate deformity. He explained the treatment plan to the patient and his parents. Nasal bridge augmentation would first be performed with a costochondral rib graft harvested from the patient. This would be followed by alar web correction surgery in the left nostril. Lateral osteotomy surgery would then be performed bilaterally resulting in correction of his broad nose deformity. The patient consented to the treatment plan. Surgical correction of the patient’s complaints Under general anesthesia, a right inframammary incision was made and a costochondral rib graft was harvested. The incision was then closed in layers with sutures. Attention was next turned to the nasal bridge augmentation surgery. An intercartilaginous incision was made in the left nostril. The lateral nasal cartilage was excised partially. Dissection was done up to the nasal bridge, which was augmented using the costochondral graft. Alar web correction surgery was then done in the left nostril. Bilateral lateral osteotomy was then performed following which closure was done intranasally using resorbable sutures. Total patient satisfaction at the results of the surgery The patient and his parents were very happy with the esthetic results of the surgery. He now had an elevated, more symmetrical, narrow, and prominent nose. This was in complete harmony with the rest of his facial features. He stated that his self confidence levels had soared up before final discharge from the hospital. Surgery Video
Wisdom Tooth Surgery – Mandibular Nerve Passing Through Tooth
Patient with pain and swelling in the posterior left mandible The patient is a 25-year-old female from Kumbakonam in Tamil Nadu, India. She had developed severe pain and swelling on the left side of her mandible. The patient had a grossly decayed left third molar. There was also severe trismus with limited mouth opening due to the presence of the infected tooth. Inferior alveolar nerve passing through impacted mandibular molar The patient had presented at a nearby dental clinic for management of her problem. An OPG had been obtained, which revealed bilaterally impacted mandibular third molars. The left third molar was grossly infected. The right third molar was completely submerged within bone and the inferior alveolar nerve was passing through the tooth. Upon viewing this, the doctor had realized that this was a complicated extraction that needed to be performed by an experienced oral and maxillofacial surgeon. He had subsequently referred the patient to our hospital for extraction of her impacted mandibular molars. Our hospital is a specialty center for complicated extractions. Molar impactions present at the lower border of the mandible are addressed here. Simultaneous extractions of bilaterally impacted maxillary and mandibular molars are routinely operated in our hospital. International acclaim from world renowned organizations Our hospital is also renowned for complex craniofacial surgery in India along with facial trauma surgery and facial cosmetic surgery. It has been widely decorated by many acclaimed international organizations. They include the World Craniofacial Foundation founded by Prof Kenneth Salyer and the International Cleft Lip and Palate Foundation founded by Prof Nagato Natsume. Initial presentation at our hospital for management of her problem Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained a detail history. He also ordered 3D CT scan and other pertinent imaging studies. The patient stated that she had severe pain and swelling in left mandibular molar region for one week. The 3D CT scan revealed bilaterally impacted lower third molars. The left molar was grossly decayed. The inferior alveolar nerve which provides sensation to the lower lip was passing through the root of the impacted right third molar. Treatment planning was explained in detail to the patient and her parents. The importance of preventing any injury to the inferior alveolar nerve was explained in detail to them. They were in agreement with the treatment plan and consented to surgery under general anesthesia. Successful surgical removal of the third molar teeth Under adequate general anesthesia, atraumatic extraction of the maxillary third molars were done. Modified Ward’s incision was utilized for extraction of the lower third molars. A flap was first raised on the left side and bone was reduced around the carious third molar tooth. This was followed by transalveolar extraction of the grossly decayed tooth. Bone was reduced to expose the submerged right third molar tooth. The tooth was then sectioned taking great care to ensure there was no damage to the inferior alveolar nerve. The sectioned parts of the tooth were then carefully extracted to prevent any damage to the nerve. The flap was then sutured using resorbable sutures. Complete patient satisfaction with resolution of pain and swelling Nerve function tests were performed and all nerve functions were fully intact. The patient was very happy that a potentially complicated problem had been solved with such ease. She did not experience any numbness and had no postoperative complications following the removal of her third molars. Surgery Video