Infected Mobile Teeth Replaced With Dental Implants
[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]This is a case of a 28 year old woman with a complaint of shaking lower front teeth, which induces pain and discomfort on chewing food. She stated that lately the saliva from the involved site is starting to taste salty. She gives a dental history of root canal treatment done to the lower anteriors 2 years back. After which an apicoectomy of the teeth was done a year back elsewhere, due to long standing cystic lesion at the root end of the teeth. Subsequently, one of her lower anterior tooth started shaking, which was then extracted and replaced with a dental implant 6 months back. Over the time there was an increase in the mobility of the adjacent teeth and the dental implant. Worried with her oral condition, she approached us seeking for a solution,that could restore her well-being.[/vc_column_text][/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=”EXAMINATION OF THE PATIENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On intraoral examination, pus discharge from the lower anterior region was evident. The anterior teeth and the implant exhibited mobility. The surrounding gum tissues were red and swollen. Full mouth X-ray (OPG) taken shows apicoectomy done to the root canal treated teeth in the lower anteriors. Infection around the implant and the teeth was evident. Blood reports affirmed no underlying systemic abnormality.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr. SM Balaji examined the patient. He suggested to extract the lower front mobile teeth and remove the infected dental implant under local anesthesia. Later, replacement of teeth with dental implants was intended. Other teeth replacement options were also explained to her. Patient opted to go for dental implants since it was considered as the best option. Patients consent was obtained before starting the procedure.[/vc_column_text][vu_heading style=”2″ heading=”PROCEDURE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under local anesthesia, Dr. SM Balaji extracted the mobile lower anterior teeth and removed the infected dental implant from the jaw bone. The recipient site was curetted and irrigated well with a sterile solution. Patient was put on antibiotics for a better healing process. A temporary removable prosthesis was given to replace her missing teeth.[/vc_column_text][vu_heading style=”2″ heading=”DENTAL IMPLANT PLACEMENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient returned after 6 months for implant placement. Her gums were well healed. There was no signs of pus discharge. X-ray taken affirmed no signs of pathological infection in the bone. Hence local anesthesia was administered. Renowned Implantologist, Dr.SM Balaji fixed the dental implants directly in the jaw bone, using the flapless technique. She was asked to wait for a healing period of 3 to 4 months to let the dental implants completely integrate with the underlying jaw bone. This aids in better retention and stability of the dental implant in the future. Meanwhile, she was asked to continue to wear the temporary prosthesis to replace her missing teeth.[/vc_column_text][vu_heading style=”2″ heading=”POST-OPERATIVE FOLLOW-UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]She approached us after 3 months for the final prosthesis. Intra oral examination confirmed no pathological findings. Post-operative OPG taken, shows well osseointegrated dental implants with no signs of infection. Hence the final measurements were taken to make the fixed prosthesis. Finally, a natural looking prosthesis was fixed onto the dental implants. The prosthesis colour blended well with her natural teeth. She was extremely happy and satisfied with the outcome. Since then she and her family has been visiting our dental hospital for regular check-ups[/vc_column_text][/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=”1/3″][vc_single_image image=”6320″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6321″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6322″ img_size=”full” add_caption=”yes”][/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=”1/3″][vc_single_image image=”6323″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6324″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column][/vc_row][/vc_section]
Honorable Health Minister of the Maldives, His Excellency Abdulla Ameen invited as Chief Guest
[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=”His Excellency Abdulla Ameen invited for International Craniofacial Conference” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji met with the Hon’ble Health Minister of the Maldives, His Excellency Abdulla Ameen and invited him to be the chief guest of the 5th International Craniofacial, Dental & Medical Summit. This was organized by the Craniofacial Research Foundation Academy in the Maldives recently.[/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=”6315″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6316″ 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=”Discussions regarding healthcare systems in the Maldives” 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 minister and Dr SM Balaji held discussions about how availability of craniofacial surgical care has improved the quality of life of those suffering from craniofacial defects in the island nation. They spoke about the commitment of the Maldivian government towards the welfare of its citizens.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6313″ 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=”Latest edition of Dhivehi book presented to the honorable minister” 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 minister thanked Dr SM Balaji for his tireless services towards providing craniofacial surgical care for his people. Dr SM Balaji presented the minister with the latest edition of his Dhivehi book, which provides information on craniofacial deformities to the Maldivian public.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”6312″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Dr SM Balaji invited to the University of California, San Francisco Dental School
Dr SM Balaji was invited as a special guest to visit the school by Dr Ophir Klein who is the Program Director of the “UCSF Program in Craniofacial Biology” during his recent trip to the country.
Dr Vitomir Konstantinovic visits Balaji Dental and Craniofacial Hospital, Chennai
Dr Konstantinovic was taken on a guided tour of the hospital by Dr SM Balaji. He met a patient with hemifacial microsomia.
Facial Asymmetry Surgery for Hemifacial Microsomia with Mandibular Distraction
Patient struggling with facial asymmetry deformity The patient is a 16-year-old male from Secunderabad in Telangana, India. His parents state that he had been born with a deformity of the mouth with a right lateral facial cleft. This is commonly known as macrostomia. He had undergone surgery for correction of his microstomia during his childhood. The parents stated that the patient has always had residual scarring from that surgical procedure. A gradually developing facial asymmetry was soon noted by the parents with the passage of time. There was underdevelopment of the right side of the face, which was becoming worse. The patient had undergone testing, which had returned with the diagnosis of hemifacial microsomia. It has now reached the point where the patient’s face demonstrated extreme asymmetry of the two sides. The patient had become completely dejected and depressed by this progressive development of facial deformity. He had faced a tremendous amount of bullying at school, which had made things worse for him. It has now reached the stage where he is refusing to attend school or at times even leave the house to attend social gatherings. The parents then began their quest at finding the right hospital for their son’s treatment. They had made enquiries all over the country. These enquiries had finally led them to our hospital. Our hospital is a premier center for hemifacial microsomia surgery in India. Scores of patients have been successfully rehabilitated in our hospital and are now leading normal lives. Hemifacial microsomia and lateral facial clefts Hemifacial microsomia is a congenital disorder that affects the development of the lower half of the face. It most commonly affects the ears, the mouth and the mandible. It usually occurs on one side of the face, but rarely involves both sides. When severe, it may result in breathing difficulties due to obstruction of the trachea, which might even require a tracheotomy. Incidence of hemifacial microsomia is in the range of 1:3500 to 1:4500 live births. This is the second most common birth defect of the face after cleft lip and cleft palate. Lateral facial clefts arise from the failure of the maxillary and mandibular prominences to fuse at the lateral commissure. This gives rise to macrostomia. Initial presentation and consultation at our hospital Dr SM Balaji, facial asymmetry surgeon, examined the patient and ordered for comprehensive imaging studies. The patient had a noticeable scar on his right cheek from the lateral facial cleft correction. There was also a gross facial asymmetry on the right side. The patient also had an occlusal cant due to his mandibular deformity. A 3D CT scan revealed a deformed right mandible with a hypoplastic ramus. It was explained that he needed to undergo mandibular ramus distraction osteogenesis surgery. This would be on the right side and would correct his facial asymmetry. A Le Fort I maxillary osteotomy was also planned for correction of the asymmetry and the occlusal cant. Facial symmetry is established when it is used for correction of asymmetrical mandible. Clinical application of distraction osteogenesis covers the entire skeleton. It is used for limb lengthening in case of limb length discrepancy. This is very safe and the resulting bone structure is both stable and strong. Soft tissue molding also happens concurrent with the bone lengthening. Bone grafts are unnecessary for this procedure. Successful surgical correction of hemifacial microsomia deformity Under general anesthesia, an incision was first made in the right submandibular region. Dissection was done up to the right mandibular ramus. This was followed by horizontal bone cuts to the outer cortex following which the mandibular ramus distractor was fixed using titanium screws. The inner cortex was then separated. Extreme care was taken to protect the inferior alveolar nerve throughout the procedure. Following this, a sulcular incision was made in the maxilla followed by a Le Fort I osteotomy. The maxilla was then mobilized. Hemostasis was achieved and closure was done using resorbable sutures. Interarch wiring was then done to stabilize the surgical site. Postsurgical phase of the treatment A latency period of about six to seven days was allowed after surgery for stabilization of the surgical site. Following the latency period, activation of the distractor was begun. This was by 1 mm every day for a period of 25 days to achieve a total mandibular advancement of 25 mm on the right side. Distraction was stopped after this period. A period of two more weeks were allowed before fixation of a straight plate to the left posterior maxilla to prevent further downward movement. Successful completion and rehabilitation of the patient After a period of about four months, radiographs were obtained to evaluate the site of distraction. This revealed complete consolidation of the bone with a reformation of a patent inferior alveolar nerve canal. The patient was extremely happy with the esthetic results of the surgery. He had a symmetrical face as well as normal occlusion with stabilization of the occlusal cant. Surgery Video
Segmental Osteotomy for Rapid Palatal Expansion and Closed Rhinoplasty
Patient with cleft lip and palate deformity undergoes surgery The patient is a 20-year-old female from Udupi in Karnataka, India. She was born with a unilateral cleft lip and palate defect. Her parents had been extensively counseled at the time of her birth. The surgical schedule of cleft repair was explained to them. The deformity involved both bone and cartilage as well as skin and tissue. She had subsequently undergone cleft lip surgery at 3 months of age. This had been followed by cleft palate surgery at 9 months of age. Cleft alveolus surgery was at 4 years of age. All these surgeries had been performed at our hospital. She had also undergone bone grafting at the site of the alveolar cleft. Increasing concern from the facial deformity As the patient grew up, her nasal deformity gradually increased. There was also inadequate development of the left maxilla. Her midface region had a depressed appearance. This resulted in a worsening facial asymmetry. Cleft lip and palate is the most commonly occurring of all birth defects. The patient had always faced a degree of bullying while in school. She had also become very self conscious of her appearance and had become withdrawn. Her parents had always been very worried about her and desired to do something to correct her facial deformity. They brought her again to our hospital for initial consultation and further management. Our hospital is a premier center for facial deformity surgery in India. Nose jobs are routinely performed at our hospital. Plastic surgeons also specialize in such surgeries. Initial presentation at our hospital for surgical correction Dr SM Balaji, facial deformity surgeon, examined the patient. He ordered extensive imaging studies for the patient. The patient expressed the opinion that her nose was ugly. She said that this made her feel very self conscious and made her withdraw from social contact. Her desire was to have a symmetrical nose with a prominent tip. She also complained of malaligned teeth in left back upper jaw region. Findings upon examination of the patient Examination revealed a repaired cleft lip and cleft palate on the left side. The left side of the nose was depressed along with a smaller nostril. She also complained of snoring during sleep. The left maxillary bone was also underdeveloped and constricted. Treatment planning for surgical correction It was explained to the patient and her parents that she would need orthodontic treatment before and after surgery. This would involve a period of six months of fixed orthodontic treatment before surgery. Surgical treatment would comprise of a segmental Le Fort I osteotomy of the left maxillary bone for correction of the posterior crossbite. This would enable maxillary correction through rapid palatal expansion in the postsurgical period. It was also planned to obtain a costochondral graft for cosmetic rhinoplasty of her depressed nose. The treatment plan was explained to the patient and her parents in detail. They expressed complete understanding of the treatment process and gave their consent to undergo facial asymmetry surgery for correction of the patient’s facial deformity. Successful surgical correction of the patient’s complaints Under general anesthesia, an incision was made in the right inframammary region and a costochondral cartilage graft was harvested. A Valsalva maneuver was then performed to rule out any perforation into the thoracic cavity. The incision was then closed in layers using sutures. This was followed by the maxillary osteotomy. An incision was made intraorally and a flap was raised to expose the underdeveloped maxilla. Segmental Le Fort I osteotomy cuts was then made and the maxillary segment mobilized. The vertical cut was made through the previously placed bone graft anteriorly. Cosmetic rhinoplasty was performed next. A transcartilagenous incision was first made in the right nostril. Dissection was then performed and the nasal dorsum was augmented using the costochondral graft. A tip graft was also placed followed by a strut graft to elevate the left nostril. Total patient satisfaction at the outcome of the surgery The patient and her parents were very happy with the results of the surgery. Her nose now appeared normal and there was better symmetry of the two halves of the face. It was explained that there would be even greater improvement following rapid palatal expander treatment. The change in her personality was immediate. She expressed that she would now face life with renewed confidence as a result of the surgery. Surgery Video
Maxillary reconstruction surgery for cleft palate
Patient born with cleft lip and palate The patient is an 18-year-old male from Erode in Tamil Nadu, India. He had been born with a left-sided cleft lip and cleft palate deformity. There was a hole in the roof of the mouth from the cleft palate deformity. Cleft lip and palate deformity does not lead to an open bite. Psychological counseling was provided for his parents on how to care for a baby with cleft lip and palate. They were also educated on the challenges that the child would face at every stage in life. It was explained that he needed the services of a good cleft team.. He was referred to our hospital for treatment. As advised by Dr SM Balaji, the patient had undergone cleft lip surgery at 3 months of age. This had been followed by cleft palate surgery at 9 months of age. He also underwent cleft alveolus surgery at 7 years of age. This was to unite the split in the maxillary bone with a bone graft. Gradual development of midfacial deformity As the patient grew up, his parents began to develop a noticeable facial deformity. His upper jaw demonstrated deficient growth and soon became retruded in relation to the rest of his face. The lip and nose were a part of the facial deformity. He also developed a cross bite of his anterior teeth due to the backward positioning of his upper jaw. This led to difficulties with speech and eating. The patient also experienced bullying at school. This was making the patient combative and belligerent. Initial presentation and treatment planning at our hospital His worried parents approached our hospital again. Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained a detailed oral history. He then ordered comprehensive imaging studies for the patient. After studying the case, he explained to the patient that he had maxillary hyperplasia. It was explained to the patient that he would need orthodontic treatment. This would help correct the malaligned teeth. Orthodontic treatment would be followed by forward positioning of the maxilla through a Le Fort I osteotomy. The patient and his parents expressed understanding of the treatment plan and consented to surgery. Our hospital is a premier center for orthognathic surgery in India. Jaw advancement surgery and jaw reduction surgery are performed routinely at our hospital. Scores of patients who had undergone jaw deformity correction at our hospital are leading completely normal lives now. Many of them had undergone complex jaw reconstruction surgery at our hospital. Maxillary hypoplasia explained in detail This condition is the underdevelopment of the maxillary bones, which produces midfacial retrusion and creates the illusion of protuberance of the lower jaw. This is a very common finding in patients with cleft lip and palate deformity. Plastic surgeons do not perform bony jaw corrections. It is also seen in Crouzon syndrome, Angelman syndrome and fetal alcohol syndrome as well as many other syndromes. Traumatic extraction of anterior teeth with resultant bone loss can also lead to this condition Successful surgical correction of the maxillary hypoplasia Under general anesthesia, a sulcular incision was placed in the maxilla. A mucoperiosteal flap was then elevated. This was followed by Le Fort I bone cuts with separation of the maxillary bone. The maxillary segment was then pulled forwards, occlusion was checked and the maxilla was stabilized and fixed using titanium plates and screws. Flap closure was then done using resorbable sutures. Complete patient satisfaction at surgical results The patient and his parents were completely satisfied with the results of the surgery. His maxilla had been brought forward with establishment of a pleasing facial profile. The patient was extremely happy with the outcome of the surgery and expressed the same to the surgical team. He said that this was a life changing event in his life. His parents expressed that the patient had become self confident as a result of this surgery. Surgery Video
Facial Asymmetry surgery with Mandibular Distraction Surgery
Patient with long standing neck pain The patient is a 31-year-old medical doctor from Gwalior in Madhya Pradesh, India. He has had significant facial asymmetry since forever. This began as a slightly asymmetrical appearance of his lower face. Feeling very self conscious about this, he had developed the habit of tilting his head towards the affected side onto his shoulder. He has had this habit for years now. This has resulted in a chronic neck pain for the patient. The neck pain too has been present for a few years now. This had been a constant irritation for him for a long time now. Of late, this neck pain had intensified and this had alarmed the patient. He had presented at a local hospital for a consultation with an oral surgeon. Following a detailed examination, the diagnosis of mandibular asymmetry had been made for the patient. The oral surgeon had advised the patient that he needed distraction osteogenesis for correction of his facial asymmetry. He had then referred the patient to our hospital for facial asymmetry surgery and orthognathic surgery. Our hospital is one of the premier centers for distraction osteogenesis in India. Facial plastic surgery is a specialty procedure at our hospital. Patients from around the world including from the developed Western nations come to our hospital for this treatment. Facial asymmetry correction at our hospital has restored normalcy to the lives of scores of patients with facial disfigurement. Initial presentation and consultation at our hospital Dr SM Balaji, distraction osteogenesis surgeon, examined the patient and obtained a detail history. It was very evident that the patient’s head posture of leaning on his left shoulder was to conceal the facial asymmetry. This had directly led to the patient developing neck pain. Comprehensive imaging studies were ordered for the patient including a 3D CT scan. Imaging studies revealed that the patient had a deficient left mandible, which was causing the facial asymmetry. The right side of the mandible was longer than the left side of the mandible. Intraoral examination revealed the presence of an occlusal cant. Treatment plan explained to the patient The correction would be on the left side even though the defect was on the right side. This was explained in detail to the patient. The mechanism of action of mandibular distraction osteogenesis was explained to the patient. It was explained that this would result in complete correction of his deformity. Successful surgical correction of facial asymmetry Under general anesthesia, an incision was made in the left mandibular retromolar region. A flap was then elevated to expose the mandibular bone. Bone cuts were then made on the outer cortex followed by fixation of the mandibular ramus distractor with titanium screws. The bone of the inner cortex of the mandible was then cut. Extreme care was taken to ensure protection of the inferior alveolar nerve throughout the procedure. Attention was next turned to the maxilla. A sulcular incision placed in the maxilla followed by Le Fort I osteotomy and mobilization of the maxilla. The posterior end of the left maxilla was then fixed using transosseous wires. Hemostasis was achieved and closure was done with sutures. Postsurgical activation of distraction device Interarch wiring was then done to stabilize the occlusion. This was followed by a latency period of about six to seven days. Following the latency period, the distractor was activated to achieve 1 mm advancement of bone each day. After achieving a satisfactory increase in length of about 16 mm, the distraction was stopped. This was followed by another latency period of one week. A plate was then fixed to the left posterior maxilla to prevent further downward movement. The distractor was finally removed after a period of three to four months. Adequate consolidation of bone at the distraction site was demonstrated through radiographs. This would ensure that the patient could return to a completely normal diet. Final outcome of the surgery The patient began noticing that there was gradual correction of his facial asymmetry during the distraction phase. He was extremely satisfied at the end of the distraction treatment. The patient’s head posture gradually improved and had completely normalized by the time of distractor removal surgery. He expressed his complete satisfaction at the results of the surgery. Resolution of his neck pain had completely transformed him. He said that he could once again fully concentrate on his medical career now that his facial deformity had been corrected. Surgery Video
Infected keratocyst excision with Jaw Reconstruction Surgery
Patient develops swelling in left lower jaw area The patient is a 27-year-old female from Chengam in Tamil Nadu, India. She began noticing the development of a swelling in her lower jaw around a year ago. This was on the left side. The swelling was not painful, but there was loosening of teeth in the affected region. This also began interfering with her eating and speech. Alarmed at the turn of events, she visited a local dental surgeon who examined her. He also obtained imaging studies for the patient. Realizing that the problem was too complex and needed surgical intervention, he referred the patient to our hospital for further management. Our hospital is a well-known center for jaw deformity surgery in India. All problems relating to jaw correction surgery are addressed at our hospital. Jaw lengthening surgery, jaw reduction surgery and jaw cyst surgery are specialty procedures performed at our hospital. Initial consultation and treatment planning Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained a detailed history. He ordered for comprehensive imaging studies including a 3D CT scan. Imaging studies revealed that there was a cystic lesion extending from the left lower canine to the third molar. There was also perforation of the lingual cortex of the mandible. Biopsy of the lesion confirmed the diagnosis of odontogenic keratocyst. He explained to the patient that total removal of affected portion of the mandible would be performed. Involved teeth in the region would also be extracted to prevent recurrence of the lesion. Hemimandibulectomy would be followed by reconstruction of the bony defect with grafts harvested from the patient’s ribs. Rehabilitation of the patient would then be completed with placement of implants through dental implant surgery. This is the treatment protocol recommended by the American Association of Oral and Maxillofacial Surgeons. It was explained that artificial crowns will be placed on the dental implants later. The artificial teeth would enable the patient to eat a normal diet. Normal speech would also be enabled by this treatment plan. The patient and her parents were in complete agreement with the treatment plan and consented to surgery. Removable dentures were not recommended to the patient. It was explained to them that meticulous dental care needed to be performed for good long term results. Characteristics of an odontogenic keratocyst An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts. Radiographically, these lesions are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cysts. Successful surgical excision of the odontogenic keratocyst Under general anesthesia, a right inframammary incision was made and dissection was carried down to the ribs. Costochondral rib grafts were then harvested for reconstruction of the jaw. A Valsalva maneuver was performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Attention was next turned to the odontogenic keratocyst. A crevicular incision was made in the mandible followed by elevation of a mucoperiosteal flap. The area of the cystic defect was identified followed by extraction of the teeth in the involved area. These included the canine, first premolar, second premolar and the three molars. Hemimandibulectomy was then performed followed by application of diathermy to control bleeding. Antibiotic flushing was also done in the region of the bony defect. The mandible was reconstructed using a mandibular reconstruction plate. Rib grafts were also fixed using titanium screws. Wound was then closed with sutures following adequate hemostasis. Follow up treatment after surgery It was explained to the patient that dental implant would be fixed on the rib grafts after consolidation with the surrounding bone. This would be followed by fixation of crowns to the dental implants after adequate osseointegration has been demonstrated with the surrounding bones. The patient and her parents expressed understanding of the treatment plan. Surgery Video
Retruded Upper Jaw Correction with Le Fort I Advancement Surgery
Patient with cleft lip and palate deformity The patient is a 19-year-old young girl from Mathura in Uttar Pradesh, India. She was born with a cleft lip, palate and alveolus. Her parents were counseled extensively after her birth. They were advised to get her deformity repaired at the appropriate ages. She first underwent cleft lip surgery at 3 months of age. This was followed by cleft palate repair at 9 months of age. Cleft alveolus repair was then performed at 4 years of age. This resulted in overall improvement in her oral health. It was advised that she would need orthognathic surgery at a later date. The degree of her facial deformity progressively increased as she grew up. It has now reached the point where she is finding it hard to bite on foods. Her upper teeth are placed inwards in relation to her lower teeth. She also said that this made her look ugly and unattractive. They realized that she would need corrective jaw surgery. This does not come under the purview of facial plastic surgery. Deciding to get this corrected, her parents took her to Kolkata to seek the advice of an Oral and Maxillofacial Surgeon. The surgeon had examined the patient and obtained radiographic studies. Upon viewing it, he realized that the degree of correction required was enormous. He then counseled the parents that this needed to be performed at a specialty jaw surgery center. The patient and her parents were then referred by him to our hospital for surgical correction of her problem. Our hospital is a premier center for jaw deformity surgery in India. Jaw correction surgery is a specialized services offered by our hospital. We are a premier center for jaw advancement surgery in India. Surgical crossbite and open bite correction is routinely performed at our hospital. Initial presentation and examination at our hospital Dr SM Balaji, jaw correction surgeon, examined the patient and obtained a detailed history from her parents. He then ordered for comprehensive imaging studies for the patient. The patient had an increased crossbite in the anterior region. Her maxilla was also positioned backwards in relation to her other facial bones. Radiological examination confirmed maxillary hypoplasia. Maxillary Hypoplasia in cleft lip and palate patients Underdevelopment of the maxillary bones, which results in midfacial retrusion is known as maxillary Hypoplasia. This condition creates the illusion of protuberance of the mandible. The size of the mandible though is normal. It is associated with Crouzon syndrome, Angelman syndrome and fetal alcohol syndrome along with many other syndromes. This can also be a byproduct of cleft lip and palate deformity. Development of treatment planning for the patient It was planned to correct the retrognathic maxilla by pulling it outwards using the Le Fort 1 surgical technique. This surgical technique is a complex one that is performed by only experienced surgeons. Results from this surgery provide good esthetic and functional correction of the patient’s problems. Successful surgical correction of the retruded maxilla Under general anesthesia, a sulcular incision was made in the maxilla. A mucoperiosteal flap was then elevated to expose the maxillary bone. Le Fort I bone cuts were made and the maxilla was separated. The separated maxillary segment was then pulled forward until there was proper occlusion of the teeth. Following this, the maxilla was stabilized and fixed using titanium plates and screws. Closure was then done using resorbable sutures. Total patient satisfaction at the outcome of the surgery The patient and her parents were extremely happy with the esthetic results of the surgery. Improvements in the functional aspects were also explained to them. It was explained to them that she could eat a more varied diet because of normalization of her occlusion. They expressed understanding of this. The patient said that she could not face the world with self confidence because of her improved appearance. Surgery Video