Blog - Balaji Dental and Craniofacial Hospital

September 10th, 2019 05:27 pm September 10, 2019

Bilateral Mandibular Distraction Osteogenesis

A fall from bed as an infant with resultant chin injury The patient is a 4-year-old boy from Chennai in Tamil Nadu, India who rolled off his crib as an infant. He had landed on his chin and had cried a lot due to the resultant pain. His worried parents had taken him to a nearby hospital where the duty doctor had examined him and prescribed analgesics. The child soon returned to his normal playful self though he had developed difficulty chewing. Parents soon noted that his facial structure was slowly changing with his chin getting retruded progressively. He also developed progressive breathing difficulties. The parents then had taken him to an oral surgeon who diagnosed bilateral ankylosis of the TMJ. He advised release of the ankylosis, which had been done. However, the patient still had difficulty with mouth opening and his breathing difficulties were also worsening. It was then that he was referred to our hospital for management of his difficulties. Our hospital is a premier center for TMJ ankylosis surgery in India. Jaw deformity surgery is routinely performed in our hospital. Distraction osteogenesis surgery is a specialty at our hospital. We were one of the first centers in India to offer this specialized jaw treatment. Initial presentation at our hospital for consultation Dr SM Balaji, Jaw Lengthening Surgery specialist, examined the patient and obtained a detailed history from the parents. They complained that he was always feeling drowsy and tired. He was listless and had difficulty breathing, particularly during sleep. Dr SM Balaji noted that the patient looked very pale and had mild cyanosis of the skin. The patient also had a backwardly positioned lower jaw. He immediately ordered for pulse oximetry and oxygen saturation tests, which revealed extremely reduced blood oxygen levels in the red blood cells. It was decided to do an emergency tracheostomy to relieve this and the patient’s skin tone immediately returned to normal. The parents were counseled that the tracheostomy needed to be in place during the entire period of jaw lengthening through mandibular distraction osteogenesis. It was explained to them that the tracheostomy needed to be retained for about 4-5 months during the entire duration of distraction treatment. Mandibular lengthening through distraction device fixation would lead to increased airway space, thus facilitating improvement in his breathing. Parents were in agreement with the treatment plan and consented to surgery. Successful completion of mandibular distraction osteogenesis Under general anesthesia, incisions were placed in the mandible bilaterally and mucoperiosteal flaps raised. Vertical bone cuts were made in the mandibular body bilaterally following which mandibular body distractors were fixed bilaterally with the activating arms exiting outwards. After a period of about five days, distraction was started by turning the distractors clockwise. The Univector distractors were distracted bilaterally by 1 mm daily for a total of 20 mm in three weeks to compensate for deficiency in growth of the mandible. Distractors retained during the period of bony consolidation The distractors were left in place for a latency period of four months. The distractors were removed once adequate bony consolidation was seen at the site of the distraction. Oxygen saturation tests were then performed to check the patient’s oxygen levels. Once it was seen to be normal, the tracheostomy was removed with complete restoration of normalcy in the patient’s life. Lower lip function including sensation was intact with complete reformation of the nerve canal. This was documented radiographically. The patient’s facial profile was also normal with lengthening of the mandible. His breathing had returned to normal following the increase in his parapharyngeal space. He was once again a very active young boy. The parents expressed their gratitude to Dr. Balaji as their child was breathing well during sleep without any signs of obstructive sleep apnea. Surgery Video frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen>

September 9th, 2019 02:25 pm September 9, 2019

smbalajiEvents 87

ICD Conference 2018 & Annual Convocation and Awards Function

September 7th, 2019 02:23 pm September 7, 2019

smbalajiSurgery 331

Unilateral Condylar Fracture Surgery | Dr SM Balaji, maxillofacial Surgeon

Young man involved in a road traffic accident The patient is a 24-year-old male from Surat in Gujarat, India. He had been involved in a road traffic accident while riding his bike. A collision with another two wheeler had resulted in his motorcycle skidding and he had landed hard on his chin. This had immediately resulted in difficulty opening his mouth and speaking. His parents had taken him to a local hospital where emergency treatment was administered. Wound debridement had been done for his superficial lacerations along with dressing. An x-ray taken at the hospital revealed a left-sided condylar fracture. The radiologist had explained to the patient that this needed to be addressed surgically at a specialty center. Due to its complicated presentation, the patient had been referred to our hospital for surgical management. Initial presentation at our hospital for treatment planning Dr SM Balaji, mandibular fracture surgeon, examined the patient and ordered an orthopantomogram and 3D CT scan to visualize the fracture. The patient was in a considerable amount of pain and had difficulty opening his mouth. He also had vertical shortening of the lower face along with a posterior open bite. There was also mild facial asymmetry with deviation of the mandible to the left side. Both the OPG as well as the 3D CT scan clearly revealed a displaced left-sided condylar fracture. It was explained to the patient that he needed condylar fracture surgery with open reduction and internal fixation along with plating to stabilize the fracture. He would also be placed in Intermaxillary fixation to promote healing of the fracture site. The area of the stylomastoid foramen in the temporal bone was not involved in the fracture. A liquid diet would be needed during the period of Intermaxillary fixation, which would be for a period of 2-3 weeks. This would be followed by a period of semi-solid diet. The patient and his parents were explained the rationale behind the treatment planning and consented to surgery. Successful surgical management of the condylar fracture Under general anesthesia, a modified Alkayat-Bramley incision was made on the left side of the face. This was just anterior and superior to the pinna of the ear. A flap was then elevated and dissection was carried out until the fracture site was identified. The displaced condylar fracture was then reduced followed by a check for normal occlusion. Once it had been determined that the fracture had been adequately reduced, it was then fixed using titanium plates and screws. Extreme care was taken to ensure that the facial nerve was adequately protected throughout the procedure. Intermaxillary fixation was applied to the jaws and the patient was instructed to follow all the postoperative instructions. The patient demonstrated full function of the facial nerve in the immediate postoperative period including furrowing of the brow and eye movements. Bite was also normal. Patient satisfaction at the results of the surgery The patient returned after a period of two weeks for removal of his Intermaxillary fixation. Facial asymmetry had been reestablished and there was no difficulty with opening his mouth. Pain was also absent and the patient demonstrated full facial nerve function without any compromise. Parotid gland function was also completely normal. There was no alteration in the taste sensation. The patient and his parents were very relieved that he had gained complete function without any sequelae from his road traffic accident. They expressed their complete satisfaction at the results of the surgery. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

September 6th, 2019 09:56 pm September 6, 2019

smbalajiSurgery 331

Condylar Fracture Surgery with Plate Fixation

Road traffic accident from a two wheeler The patient is a 45-year-old woman from Chennai in Tamil Nadu, India. She was involved in a road traffic accident while crossing the road as a pedestrian. A speeding motorcycle knocked her down with her chin impacting the asphalt. The biker had immediately left the scene and she had been taken to a nearby hospital by onlookers. The patient suffered no external injuries from the impact. Her jaw was slightly displaced to the right side. Referral to our hospital for treatment of her fractures She complained of pain and difficulty opening her mouth upon initial presentation at the hospital. Imaging studies had been taken at the hospital and had revealed that she had fractured the right condylar head of the mandible. She had undergone condylar fracture surgery, but it had resulted in a malunited fracture due to the pull of the lateral pterygoid muscle. Faced with eating and speech difficulties, the patient had presented again at the hospital. Realizing the complexity of the treatment involved to correct the malunited fracture, the doctor had immediately referred her to our hospital for management. Our hospital is a premier center for jaw fracture surgery in India. Even complicated comminuted jaw fractures are addressed at our hospital with excellent results. Initial presentation at our hospital for management Dr SM Balaji, jaw fracture surgeon, examined the patient and ordered comprehensive imaging studies including a 3D CT scan. Imaging studies revealed a displaced malunited condylar fracture on the right. The displacement was due to the pull of the lateral pterygoid muscle. Treatment planning was then done after ascertaining the extent of injuries. The patient had deviation of the mandible to the right side along with a right-sided posterior open bite. It was explained to the patient that she would need re-fracture of the malunited fracture. This would be followed by internal fixation using titanium plates and screws. She would also need to stay on a liquid diet for about two to three weeks. This would be followed by a semi-solid diet for another week to ten days. The patient and her husband were in agreement with the treatment plan and consented to surgery. Successful surgical reduction and stabilization of the fracture Under general anesthesia, a modified Alkayat Bramley incision was made on the right side of the face. A flap was then elevated following which the malunited fracture site was exposed. The region of malunion was then refractured. This was followed by reduction of the displaced condylar segment. Occlusion was then checked and found to be perfect. The fracture was stabilized and fixed using titanium plates and screws. It was now resting stable within the glenoid fossa. Special care was taken to ensure that the facial nerve was not damaged during the procedure. Facial nerve paralysis is a complication that could arise from the surgery. This is usually caused by intraoperative damage inflicted upon the facial nerve from its point of exit in the temporal bone during surgery. Care also has to be taken to not cause any injury to the parotid gland. Complete patient satisfaction at the outcome of the surgery Immediate postoperative check for facial nerve function showed normal facial nerve function. The patient was able to furrow the forehead and open and close his eyelids. There were no complications arising from the surgery. Results were apparent immediately after the surgery. The patient was satisfied with the outcome of the surgery. She was able to open and close her mouth again with no pain or discomfort. There was also complete restoration of normal occlusion following surgery. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

September 5th, 2019 08:32 pm September 5, 2019

smbalajiSurgery 331

Cleft Rhinoplasty with Lip 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 born with a cleft lip and palate deformity” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient is a 25-year-old female from Jaipur in Rajasthan, India who was born with a cleft lip, palate and alveolus. A cleft palate defect results in a hole in the roof of the mouth. This results in regurgitation of fluids from the mouth through the nose. Cleft palate repair would result in closure of this communication between the oral cavity and the nose. She had undergone cleft lip surgery at 3 months of age and cleft palate surgery at 9 months of age. This had been followed by cleft alveolus surgery at 4 years of age. These had been performed at the correct recommended times for these surgeries. The patient however developed a crooked nose with growth and age. She had always felt that her nose was asymmetrical and not in harmony with her face. This made her feel self conscious and depressed. Another complaint the patient had was about the facial scar on her upper lip as well as a few missing teeth. She has already been operated twice for the nose and multiple times for the lips. A request was made for nose reshaping surgery. Plastic surgeons also perform this surgery. She had approached a local cosmetic surgeon who had thoroughly examined the patient. He had advised her that she needed to see a cleft rhinoplasty surgeon. The patient had then been referred by him to our hospital. Our hospital is a premier center for cleft rhinoplasty surgery in India.[/vc_column_text][vu_heading style=”2″ heading=”Initial presentation at our hospital for treatment planning” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji, nose correction surgeon, examined the patient and studied her old medical records. She was a case of left sided unilateral cleft lip and palate. Her nose appeared bulky. There was no symmetry in the upper lip. The vermillion border was uneven. There was lack of sufficient alveolar bone in relation to the left lateral incisor for placement of a dental implant. Bone grafting would need to be performed at this site of implant placement at a later date. Decision was made to harvest the graft from the retromolar region. It was explained to the patient that she needed lip scar revision surgery as well as nose correction with bilateral lateral osteotomy and removal of the medial crus of the nose. A bone graft would be utilized to reconstruct the defect in the alveolar bone. This would be followed by dental implant surgery after consolidation of the alveolar bone graft. He also explained that no grafting of skin or skin flaps will be required for these procedures.[/vc_column_text][vu_heading style=”2″ heading=”Successful surgical correction of the facial deformities” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under general anesthesia, lip revision surgery was first performed followed by closure of the incision with sutures. A bone graft was next harvested from the left retromolar region. This was then used to reconstruct the patient’s alveolar defect. Nose correction was performed next. An incision was made in the right nostril and medial nasal cartilage was excised. Lateral osteotomies were then performed bilaterally. Intranasal and intraoral incisions were then closed utilizing resorbable sutures.[/vc_column_text][vu_heading style=”2″ heading=”Complete patient satisfaction at the results of the surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The results of the surgery were visible immediately. The patient was very happy with the outcome of the surgery. She no longer had a bulky nose and had a more symmetrical nose. The result of her lip revision surgery was also very pleasing to her. She expressed her happiness to the surgeon and thanked him for helping her to regain her confidence.[/vc_column_text][vu_heading style=”2″ heading=”surgery video” subheading=”” alignment=”left” custom_colors=”” class=””][vc_video link=”https://youtu.be/PNkCEx2LFU8″][/vc_column][/vc_row][/vc_section]

September 1st, 2019 07:25 pm September 1, 2019

smbalajiEvents 87

Prof SM Balaji at the 13th World Cleft Lip and Palate Congress and 59th World Teratology Congress in Nagoya, Japan as invited faculty.

Prof SM Balaji, an eminent Chennai-based Oral and Craniofacial Surgeon attended the 13th World Cleft Lip and Palate Congress held in Nagoya, Japan. This was held in conjunction with the 59th Congress of the World Teratology Society. He is amongst the earliest members of the board of the ICPF. As one of the leading Cleft Lip and Palate Surgeons in the world, he was requested by the Board of the ICPF to toast the over 500 delegates from 79 countries who were in attendance at the congress. He delivered it in his usual style, peppered with his trademark humor with an underlying message to serve humanity. width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

August 31st, 2019 09:43 pm August 31, 2019

smbalajiSurgery 331

13th World Congress of the International Cleft Lip and Palate Foundation

The 13th ICPF World Congress in Japan Dr SM Balaji attended the 13th ICPF (International Cleft Lip and Palate Foundation) World Congress in Nagoya, Japan. He is a member of the Board of Trustees of the ICPF as well as Editor-in-Chief of the ICPF newsletter. The ICPF Board of Trustees comprises of the premier cleft lip and cleft palate surgeons in the world who come together at the yearly world congress to assess the work done in the previous year and to formulate plans for the upcoming year. The Board of Trustees meeting discussed ways of incorporating various allied fields into the ICPF to address the pressing needs of patients with various birth defects. The meeting was helmed by Dr Nagato Natsume, Secretary-Treasurer, who is also the founder of the ICPF and Prof Kenneth Salyer who is the President of the ICPF. Prof Salyer holds the distinction of having performed the first successful separation of conjoined twins in the world. Dr SM Balaji is a premier Chennai-based cleft lip and palate surgeon whose surgical innovations have been widely adopted throughout the world by other surgeons. His surgical flap designs have resulted in improved esthetics and function for the patient. Widening the scope at the 13th Congress of the ICPF at Nagoya The ICPF was founded in 1997 as a humanitarian, nonprofit organization whose aim was to address the sufferings of patients born with cleft lip and palate deformities. It has exponentially grown over the years and now conducts surgical missions to poor underdeveloped countries around the world for the rehabilitation of cleft lip and palate patients. This year’s congress was held in conjunction with the 59th Annual meeting of the Japanese Teratology Society at the picturesque city of Nagoya in Japan. This is in lieu with the decision of the Board of Trustees of the ICPF to address a greater number of birth defects that plague humanity. The vision of the ICPF is to completely eliminate the occurrence of cleft lip and palate through genetic studies aimed at identifying the genes responsible for cleft formation. Participation of the American Society of Teratology at the congress This year’s congress saw the participation of the American Society of Teratology for the first time at the ICPF congress. It was represented by the President, Dr Elise M Lewis who spoke at length about the increase in the incidence of birth defects around the world. She spoke about the challenges facing the medical field in this regard. Dr SM Balaji and Dr Elise Lewis held discussions about collaborations between India and the United States of America towards addressing this problem. They agreed that environmental factors were increasingly becoming a factor in the occurrence of birth defects. Dr SM Balaji’s keynote lecture at the conference The topic of Dr SM Balaji’s keynote lecture at the conference was the “Management of Orbital Dystopia.” He presented cases from his over 25 years of surgical experience in correcting this deformity. His lecture was followed by a lively Question and Answer session in which he addressed a variety of queries posed by the distinguished audience. Dr SM Balaji received a Certificate of Appreciation from Dr George Sandor at the end of his keynote lecture. Dr SM Balaji meets Dr Akiro Yamada at the congress Dr SM Balaji attended the microtia workshop conducted by Dr Akiro Yamada. He held discussions with Dr Yamada regarding the various surgical techniques utilized for ear reconstruction. They discussed about the morphological differences in the human ear found in people around the world. The workshop was a resounding success with contributions from leading microtia surgeons from around the world. This year’s congress concluded on a positive note with the decision to include a greater number of birth defects under the ICPF umbrella being lauded by all those in attendance. Everybody pledged their commitment towards the ideals of the ICPF of alleviating suffering cause by birth defects and other genetic anomalies.

August 27th, 2019 09:16 pm August 27, 2019

smbalajiDental Implant 14

Replacement of compromised teeth and space closure 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 52 year old female patient with a complaint of mobile lower front teeth. The patient stated that she’s been experiencing severe mobility of her lower front teeth for a while as a result of which one of her lower anterior had fallen out recently. Since then, the gaps between her lower front teeth have started to get wider and the persistent mobility of her teeth often gave her tough time pronouncing certain words. The unpleasant look of her lower teeth worried her. She requested for a solution to bridge the gap between her teeth in order to restore the normalcy of her oral function and appearance. Patient gives a medical history of hypothyroidism, diabetes for the past 10years and is known to be on medication.[/vc_column_text][vu_heading style=”2″ heading=”EXAMINATION OF THE PATIENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, the lower anteriors exhibited severe mobility with missing right central incisor. On radiological examination, OPG taken shows generalized bone loss and surrounding tissue attachment loss in all the teeth. Blood investigation revealed thyroid level under control with the blood glucose level slightly above the normal range.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]With the patients demand in consideration, Dr.S.M.Balaji planned to extract the mobile anteriors followed by fixation of Dental implants under local anesthesia. A course of periodontal therapy (gum treatment) was also intended, as the supporting gum tissues were weak due to underlying periodontal pathology. The surgical procedure was briefed and patients consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”PROCEDURE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under local anesthesia, the mobile lower anteriors were extracted, followed by elevation of the surrounding gum tissues to expose the underlying jaw bone. Secondly, dental implants of appropriate size were fixed in the bone with utmost stability and precision. Finally, the gum tissues were approximated covering the dental implants with absorbable suture.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT FOLLOW-UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A course of antibiotics and painkillers were given for 3 days to cope up with the mild postoperative discomfort. Patient was educated on the postoperative home oral regime. She was asked to report after 3 months for the final prosthesis, to let the dental implants completely osseointegrate with the jaw bone. For the time being, a removable prosthesis was given to the patient to replace her missing teeth.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT OUTCOME” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Post-operative OPG taken after 3months shows well integrated dental implants with the surrounding bone. Hence the final impression was taken, followed by few trials of bite alterations of the final prosthesis. A natural looking ceramic bridge was fixed onto the dental implants covering the unpleasant gap which was worrying the patient. There was an immediate improvement in the patient’s speech and she was more than happy with the outcome.[/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=”6134″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6135″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6136″ 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=”6137″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6138″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6139″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row][/vc_section]

August 26th, 2019 09:33 pm August 26, 2019

smbalajiSurgery 331

Pediatric Jaw Fracture Surgery | Dr SM Balaji, Maxillofacial Surgeon, India

Road traffic accident while playing cricket The patient is a 4-year-old boy from Kayalpatnam in Tamil Nadu, India. He had been playing cricket and had run across the road to collect the ball. A motorcycle had collided with him and he had landed hard with his jaw hitting the asphalt. There was a laceration at the symphyseal region and extreme pain. The motorcyclist had left the scene immediately after the accident. His concerned parents had immediately taken him to a nearby hospital for treatment. The laceration was debrided and dressing was done. An x-ray revealed a fracture in the anterior region of the mandible. Tetanus toxoid had also been administered to the patient at the hospital. He was advised to undergo fracture fixation with plates and screws. Patients advised against usage of plates and screws for child However, the parents were advised against this by a family friend who is an orthopedic surgeon. The orthopedic surgeon then referred the patient and his parents to our hospital for management of his fracture. The bones of children are unlike adult bones. An adult bone breaks easier while a child’s bone bends. Fractures in children heal faster. Care should be taken to not disrupt the growth plates. Closed reduction with active range of motion is the ideal treatment for simple childhood fractures. Our hospital follows all the surgical protocols laid out for pediatric fracture surgery by the American Association of Oral and Maxillofacial Surgeons. Our hospital is a premier center for pediatric oral and maxillofacial surgery in India. We are a central referral center for cleft lip and cleft palate surgery in Southeast Asia. Pediatric fracture surgery is routinely performed in our hospital. All the latest radiographic imaging modalities are available in house for easy diagnosis and treatment planning of cases. Initial presentation at our hospital Dr SM Balaji, Pediatric Fracture Surgeon, examined the patient and ordered comprehensive diagnostic testing for the patient. The patient was unable to open his mouth. The parents stated that he was not able to chew food and that his appetite had gone down considerably following the accident. Imaging studies obtained included an OPG as well as a 3D CT scan. These revealed a symphysis fracture and a displaced left condylar fracture. Surgical treatment planning for the patient The patient’s parents were advised that the symphysis fracture was best addressed through a cap splint. It was also explained that fixation of the condylar fracture would be unnecessary as the occlusion would be maintained by the cap splint. This would allow for total union of his condylar fracture. It was also advised that he would need to stay on a liquid diet for about 2-3 weeks followed by a semi-solid diet. The patient was scheduled for pediatric jaw fracture surgery for his pediatric condylar fracture correction. Successful surgical correction of the fracture Under general anesthesia, an impression was taken of the mandibular arch and a cap splint fabricated. The cap splint was then placed on the lower jaw and wired using circum mandibular wiring. Chin laceration was also sutured using resorbable and nonresorbable sutures. The fracture site was thus reduced using cap splint, thereby limiting movement of the jaw and enabling bone healing. Parents of patient express complete satisfaction The surgery was successful with no complications. Parents were very satisfied with the outcome of the surgery. After a period of about one month, the wires were removed under general anesthesia after the fracture site showed considerable healing. The patient was able to open and close his mouth again with no pain or discomfort. Parents were very thankful as they had been initially worried about the possible long term complications that could affect the boy’s quality of life. Surgery Video frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen>

August 25th, 2019 05:21 pm August 25, 2019

smbalajiSurgery 331

Mandibular Reconstruction with Rib Graft

Patient develops a deformity of the left side of the face The patient is a 44-year-old patient from Bilaspur in Chattisgarh, India. He was fine until approximately two years ago. It was then that he began noticing a swelling develop on the left side of his lower jaw. Alarmed by this, he had presented at a local maxillofacial hospital for diagnosis and management. A detailed examination had been performed followed by comprehensive imaging studies and a biopsy. The patient had been diagnosed with an odontogenic keratocyst. He had been advised plastic and reconstructive surgery for management of his condition. Of note, the patient himself is a medical doctor. Characteristics of an Odontogenic Keratocyst An odontogenic keratocyst is a rare, benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of all jaw cysts. Radiographically, most are unilocular in presentation when present at the periapex. They can be mistaken for a radicular or lateral periodontal cyst. Removing the cyst completely would entail removal of the surrounding tissues. There are many types of cysts that occur in living organisms. A dentigerous cyst occurs in relation to an impacted tooth. Other cysts include sebaceous cysts, epidermoid cysts, pilar cysts and ovarian cysts. Recurrence rates vary with the kind of cysts. Pilar cysts are associated with infected hair follicles. Odontogenic keratocysts sometimes occur in conjunction with nevoid basal cell carcinoma syndrome. Initial surgical intervention for his odontogenic keratocyst The patient had undergone a hemimandibulectomy around 3 years ago for removal of his odontogenic keratocyst. His mandible was then reconstructed using titanium plates and screws. This had resulted in a gross deformity of the left side of his face. The screws of the plate also showed evidence of loosening. He also experienced extreme difficulty with chewing and speech. This had left him very depressed and he sought the help of his friends in finding a solution to his problem. His friends searched far and wide for the best hospital to treat him. Their enquiries finally convinced them that our hospital was the right choice for him. They then informed the patient that his problem would be best addressed at Balaji Dental and Craniofacial Hospital in Chennai. The patient and his wife then made an appointment to meet Dr SM Balaji, facial deformity surgeon. Initial presentation at our hospital for management and treatment Dr SM Balaji, cyst removal surgeon, examined the patient and studied his old case records in detail. He then ordered comprehensive imaging studies including a 3D CT scan for the patient. The patient had a gross deformity of the face with a left-sided asymmetry. There was also a slight deviation of the mandible to the left side. Imaging studies revealed the presence of the titanium reconstruction plate fixed to the left condyle with loosened screws. There was no recurrence of the odontogenic keratocyst at the site. Formulation of treatment plan for the patient The patient expressed that he was not interested in undergoing microvascular reconstructive surgery. Hence it was explained to the patient that reconstruction with rib graft surgery would offer the best results. This would involve harvesting a rib graft from the patient at the time of surgery. It was also explained that dental implants would be placed once the rib grafts are consolidated. This would ensure return to complete normal function for the patient. The patient was in agreement with the treatment plan and consented to surgery. Successful surgical correction of the patient’s facial deformity Under general anesthesia, a right inframammary was incision placed and dissection was carried down to the ribs. A costochondral rib graft was then harvested to be used for the mandibular graft surgery. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers using sutures. Attention was then turned to the reconstruction of the mandible. A midcrestal incision was made in the left mandible followed by elevation of a mucoperiosteal flap. Mandibular reconstruction was then performed using the rib graft along with the same mandibular reconstruction plate. Hemostasis was achieved followed by closure of the incision with sutures. Complete patient satisfaction with the results of the surgery The patient was very happy with the outcome of the surgery. There were no scars present as all the incisions had been made intraorally. Facial asymmetry had been achieved with the reconstruction of the mandible. His facial appearance was back to baseline following surgery. It was explained that dental implants would be placed on the bone graft after consolidation of the grafts. This would be followed by placement of crowns after complete osseointegration of the implants. The patient expressed complete understanding of the future treatments and would return in 3-4 months for placement of dental implants. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

Bilateral Mandibular Distraction Osteogenesis

ICD Conference 2018 & Annual Convocation and Awards Function

Unilateral Condylar Fracture Surgery | Dr SM Balaji, maxillofacial Surgeon

Condylar Fracture Surgery with Plate Fixation

Cleft Rhinoplasty with Lip Surgery

Prof SM Balaji at the 13th World Cleft Lip and Palate Congress and 59th World Teratology Congress in Nagoya, Japan as invited faculty.

13th World Congress of the International Cleft Lip and Palate Foundation

Replacement of compromised teeth and space closure with dental implants

Pediatric Jaw Fracture Surgery | Dr SM Balaji, Maxillofacial Surgeon, India

Mandibular Reconstruction with Rib Graft

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