Micrognathia (Lower Jaw Hypoplasia) Bilateral Sagittal Split Osteotomy
Patient with a disproportionately small lower jaw The patient is a 21-year-old male from Bhopal in Madhya Pradesh, India. His lower jaw has been very small ever since he can remember. He said that he has always had trouble with speech and eating. Snoring has also been a chronic problem for him. He stated that this had made his facial profile appear concave and he hated it. The patient had faced significant bullying at school and in college. This had caused him to become socially withdrawn and he had few friends. He had the tendency to avoid all social gatherings and led a rather lonely life. This had greatly worried his parents and they had approached a local oral surgeon who examined the patient. Realizing the degree of deformity, the surgeon had referred them to our hospital for corrective jaw surgery. Specialty center for Oral and Maxillofacial Surgery Our hospital is a referral center for complicated cases requiring oral and maxillofacial surgery. All the protocols laid down by the American Association of Oral and Maxillofacial Surgeons are rigorously followed by us. We are renowned for orthognathic surgery and facial cosmetic surgery. Surgery costs are also economical when compared with developed Western countries. Open bite correction is a routine part of orthognathic surgery. Follow up of cases is done long term after surgery with excellent results. Documentation of cases helps in the process of long term follow up of cases. The latest technology is used for the maintenance of up to date patient records. The patient had always wished to have a masculine appearing prominent lower jaw. He felt that surgical correction of his jaw along with the resultant profile correction would solve all his problems. Our hospital is a premier center for jaw deformity surgery in India. We perform all jaw surgeries ranging from cosmetic jaw surgery to jaw surgery for pathological conditions such as cysts, tumors, etc. What is micrognathia? Micrognathia is a condition where the jaw is undersized. It is also sometimes called “mandibular hypoplasia”. This condition is common during infancy. It however is usually self correcting during growth with a gradual increase in the size of the mandible to normal size. Since the jaw size discrepancy will be pronounced during infancy, it can lead to abnormal alignment of teeth. When this is severe, it can even lead to disruption in the feeding patterns of the infant. A surgical implication of micrognathia in both children and adults is that it can made intubation difficult. Anesthesia is induced through awake bronchoscopic intubation in the presence of micrognathia. Micrognathism, which is true hypoplasia of the mandible is different from retrognathism, which is a backwardly positioned mandible. Initial presentation at our hospital for management of his problem Dr SM Balaji, jaw deformity surgeon, examined the patient and obtained a detailed history. Comprehensive imaging studies were obtained for the patient. The patient had an anterior deep bite with class II malocclusion. His lower jaw was retruded and his face had a concave profile. Treatment planning was performed for the patient and he was advised to undergo lower jaw advancement surgery by about 10 mm. It was also explained to him that he would need postsurgical orthodontic treatment for correction of his dental malocclusion. The patient and his parents were in agreement with the jaw osteotomy and consented to surgery. All incisions will be made intraorally to avoid external scarring. Successful correction of the patient’s micrognathia Under general anesthesia, incisions were made in mandibular retromolar region bilaterally. Following this, flaps were elevated and bone cuts were made in the mandible. Bilateral sagittal split osteotomy was performed using Obwegeser’s technique. Extreme care was taken to protect the inferior alveolar nerve throughout mobilization of the proximal and distal segments of the mandible. The distal segment of the mandible was advanced by about 10mm. Occlusion was checked, bone was stabilized and fixed using titanium plates and screws. Closure was then done using resorbable sutures. Complete patient satisfaction at the outcome of the surgery The patient and his parents were very happy with the surgical outcome as the cosmetic improvement was immediate. His occlusion had become normal and he now had a prominent jaw line and masculine facial profile. He also said that his speech had improved to a great extent following the surgery. The patient was instructed to return in a few months time for fixed orthodontic treatment. This would help in correction of his malaligned teeth. It was explained that completion of orthodontic treatment would complete rehabilitation of his dentofacial problems. Surgery Video
Revision rhinoplasty – Recreating the External Nares Opening Surgery
Patient born with a bilateral cleft lip and palate The patient is a 14-year-old boy from Vadodara in Gujarat, India who was born with a bilateral cleft lip and palate. This is amongst the most common birth defects. Children born with these deformities need to be operated early. He had undergone cleft lip surgery at 3 months of age and cleft palate repair at 9 months of age. Delayed cleft palate repair would lead to improper speech development. This had been followed by a nose correction surgery at 5 years of age and an Abbe flap and lip revision at 7 years of age. The nose correction had been redone at 8 years of age. All these surgeries had been performed at a local hospital. Patient extremely unhappy with surgical results The patient had been left with a depressed nose and a completely closed right naris. There was both bone and cartilage insufficiency. He had extreme difficulty breathing. Even a minor nasal infection like a common cold caused him a great deal of distress. Added to this, he had an extremely unsightly scar at the region of the surgery. His nose was also asymmetrical and flat. The patient and his parents were therefore highly dissatisfied with the results of the previous rhinoplasty. He desired a nose job that would raise his nose and make it in harmony with the rest of his face. Children with cleft lip and palate deformity face difficulties during interaction with peers. They are perceived as being different and may face bullying. Parents of children both with these deformities have to be very supportive. They should take care not to express any negative emotions towards children with cleft lip and palate. At the same time, they should ensure that the children are brought up in a normal atmosphere. Care should be taken to not spoil these children. The patient had been feeling very depressed about this and his parents consulted a local cosmetic surgeon to address this problem. He had examined the patient and obtained imaging studies. Realizing the complexity of the problem, he had referred them to Balaji Dental and Craniofacial Hospital for surgical correction. Our hospital is a premier centre for rhinoplasty surgery in India. We also deal with all other facial cosmetic surgery procedures. Initial presentation at our hospital for consultation Dr SM Balaji, cosmetic rhinoplasty surgeon, examined the patient and obtained a detailed history. He then ordered comprehensive imaging studies for the patient. This had revealed that the patient did not have a right nostril. He also had a depressed nasal bridge and the columella was also absent. Treatment planning for correction of the patient’s problems The aim of the surgery was primarily to create a new hole for his right naris. Detailed treatment planning was done for the patient. Skin from the right nasolabial region would be utilized to create the nasal floor. A vestibular mucosal flap would be utilized for columellar reconstruction. It was also decided to elevate the dorsum of the nose using a double deckered costochondral rib graft. Bone grafts would not need to be harvested. The nose tip was to be elevated using a strut graft. This was explained to the parents who were in agreement and consented to surgery. Surgical correction of the patient’s facial deformities Under general anesthesia, an incision was made in the right inframammary region and costochondral graft was harvested. 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. Following this, using the open rhinoplasty technique, the depressed nasal bridge was augmented to recreate perfect nasal form using the costochondral graft. The strut graft was next placed to elevate the tip of the nose. Right nostril was then created using a triangular flap of tissue from the nasolabial region. This was followed by creation of the columella using a flap of tissue from the upper lip. Once complete hemostasis had been achieved, closure was done using both resorbable and nonresorbable sutures. Successful outcome to the surgery The patient and his parents were very happy with the results of the surgery. They said that the patient’s face was in harmony now. His facial esthetics had been restored by the surgery and he would now be able to face the world confidently. Surgery Video
Hemifacial Microsomia – Reconstruction of Ramus and Condyle by costochondral Graft
Patient with gradually worsening facial asymmetry The patient is an 8-year-old boy from Meerut in Uttar Pradesh, India. His parents had begun noticing a developing facial asymmetry as he grew up. It has now reached the point where it is very visible and this has greatly distressed his parents. The patient too has been facing a lot of bully at school and does not have many friends. They had approached a local doctor who had explained to them that their son had hemifacial microsomia. He had further explained the treatment protocol for hemifacial microsomia and had referred them to our hospital for treatment. Our hospital is a premier center for hemifacial microsomia surgery in India. Facial reanimation surgery is performed on a regular basis in our hospital. Patients from all over the world are referred to our hospital for hemifacial microsomia treatment. What is hemifacial microsomia? 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 lower jaw. It mainly manifests on only one side of the face, but may rarely involve both sides. When hemifacial microsomia is severe, it may cause breathing difficulties from tracheal obstruction. This may even require a tracheotomy. It is the second most common birth defect of the face after cleft lip and palate. Incidence rate is one out of every 3500 to 4500 live births. Children born with hemifacial microsomia could face difficulties at school and at social settings. Their facial features are perceived as being different. This could lead to a sense of isolation and loneliness in these children. Parents too need counseling to overcome feelings of despair and depression. Improper handling of these children during the growing years could lead to permanent psychological scarring. Common features seen in this condition The affected side has the appearance of facial paralysis. However, there is no involvement of the facial nerve. Soft tissue disfigurement is a prominent feature of this condition. The lower areas of the face are mainly affected. Microtia too is a common feature. Cleft lip and cleft palate are not associated with this condition. Orthognathic surgery could be required to correct the jaw deformity. Craniofacial centers specializing in reconstructive surgery are well equipped to handle these cases. Correction of drooping corner of the mouth is performed by reanimation surgery using fascia lata grafts. Hemifacial microsomia shares many similarities with Treacher Collins syndrome, Franceschetti syndrome, Goldenhar syndrome and Parry-Romberg syndrome. Initial presentation at our hospital for hemifacial microsomia treatment Dr SM Balaji, hemifacial microsomia surgeon, examined the patient and obtained a detailed history. He then ordered for comprehensive imaging studies including a 3D CT for the patient. The patient had facial asymmetry on the right side. His 3D CT scan revealed the absence of the condyle and coronoid on the right side along with a hypoplastic ramus. The patient also had microtia on the right side. There was also the presence of a noticeable occlusal cant. Treatment planning explained to the parents A right sided ramus distraction osteogenesis was planned for correction of the patient’s facial asymmetry. Bone was however not sufficient for performing the distraction osteogenesis. Plan was to create a condyle using a costochondral graft with a growth centre and reinforce the mandibular ramus. This would enable the presence of sufficient bone for performing distraction osteogenesis later. Successful surgical creation of condyle on the right side Under general anesthesia, a right inframammary incision was made and a costochondral rib graft was harvested. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Next, a right submandibular incision was made and dissection was done up to the condyle. The coronoid was created and the ramus was augmented using the costochondral rib graft, which was fixed using titanium screws. Closure of the wound was then done using resorbable sutures. Optimal anatomical coronoid, condyle and ramus structures The surgery was a complete success. Coronoid was successfully created and ramus was augmented. A postoperative OPG taken after 3 months revealed sufficient bone consolidation. The patient now had a more symmetrical face. It was explained that the patient needed to return in six months for distraction osteogenesis. That would then be followed by reconstruction of the patient’s ear after sufficient growth has occurred. Correction of facial deformity greatly benefits patients suffering from hemifacial microsomia. Surgery Video
Visit of Dr Andrew Edwards, Dean-Elect, Faculty of Dentistry, Royal College of Surgeons, Glasgow
[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=”Visit of Dr Andrew Edwards to Balaji Dental and Craniofacial Hospital” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr Andrew Edwards was invited to visit Balaji Dental and Craniofacial Hospital by Dr SM Balaji, a renowned Chennai-based Cranio-maxillofacial surgeon. The distinguished oral and maxillofacial surgeon who is the Dean-Elect of the Faculty of Dentistry, Royal College of Surgeons, Glasgow, visited the hospital with his team of surgeons. They were warmly welcomed at the hospital by Dr SM Balaji, Dr Preetha Balaji, Consultant Oral and Maxillofacial Surgeon and Dr Varsha Balaji, postgraduate MD student in Obstetrics and Gynecology.[/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=”5977″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5978″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5979″ 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=”” width=”1/3″][vc_single_image image=”5981″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5982″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Dr SM Balaji gives a guided tour of the dental clinic to the visitors” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The visitors were first given a guided tour of the dental clinic by Dr SM Balaji. The various treatments offered at the clinic were explained to them as were the safety protocols regarding asepsis and sterilization practices at the clinic. Dr Edwards and his team were suitably impressed and said that this was on par with the standard treatment protocols prescribed by the Royal College of Surgeons, Glasgow.[/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=”5984″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5986″ 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=”Interaction with patients at the hospital” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr Edwards and his team were then taken for ward rounds by Dr SM Balaji and met with some of the patients. They viewed preoperative photographs of the patients and Dr SM Balaji explained some of the challenges and the steps taken to overcome them in a third world setting.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5989″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5990″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5991″ 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=”” width=”1/3″][vc_single_image image=”5992″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5993″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5994″ img_size=”full”][/vc_column_inner][/vc_row_inner][vc_column_text]Dr Edwards expressed his appreciation at the innovative techniques evolved by Dr SM Balaji to provide results that were world class.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5996″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5997″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5998″ 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=”Challenging cases performed at the hospital” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr Edwards and his team then interacted with Dr SM Balaji and his team over hors d’oeuvres at the conference hall. They viewed slides/videos of surgeries performed on syndromic patients with craniofacial deformities with preoperative and postoperative photographs. Dr Edwards expressed his appreciation of the services rendered by Dr SM Balaji for patients who would otherwise have a very poor quality of life due to their craniofacial deformities. The visiting team expressed their appreciation to Dr Balaji for having provided them with an insight into the quality of medical care being provided at the hospital.[/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=”5999″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6000″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6001″ 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=”” width=”1/3″][vc_single_image image=”6002″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6003″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6004″ 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=”” width=”1/3″][vc_single_image image=”6005″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column][/vc_row][/vc_section]
Dental Implants for Malaligned Mobile Teeth
[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=”CASE REPORT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This is a case of a 32 year old female patient, who approached our dental hospital with a complaint of mobile lower front teeth. The patient stated that her lower anteriors started to shake a year back, which over time led to severe mobility. She was also concerned with the malalignment of her lower anteriors. As a result of mobility and crooked teeth, patient felt difficulty to bite food as it caused mild pain and discomfort. Patient wanted to correct her malalignment as well as find a solution for her shaking teeth. Patient is said to be pre-diabetic and under medication for past 1 year.[/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 patients lower anteriors appeared to be crowded and malaligned. The gum tissue surrounding the relative teeth seemed to have mild inflammation with bleeding on palpation. On radiological examination,OPG taken shows moderate generalized bone loss in all teeth except for the corresponding lower anteriors which considerably had slightly more bone resorption, due to poor oral maintenance of the patient. A thorough blood analysis revealed no systemic abnormalities. Blood glucose level was under control.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]With regard to the patients concern on malalignment and mobility, Dr S M Balaji planned to extract the shaking teeth in the lower front region and replace the missing teeth with dental implants under local anesthesia. Patient was briefed about the procedure and 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 extraction of the corresponding lower front teeth was carried out following thorough irrigation of the extracted teeth socket. The gum tissue surrounding the site has been raised exposing the underlying jaw bone. Following that, dental implants of desired size were fixed in the bone. Final closure of the gum tissue was obtained with absorbable suture. A three day course of antibiotics and painkillers has been prescribed to the patient to cope up with the post- surgical mild discomfort. Patient was educated on the post-operative oral maintenance instructions to be followed at home. The patient was asked to report after 3 months for placement of the final prosthesis, to ensure the dental implants integrates well with the jaw bone and to attain maximum stability and retention of the fixed prosthesis. Meanwhile, a removable prosthesis has been given to the patient to replace the missing teeth for the time being.[/vc_column_text][vu_heading style=”2″ heading=”THE FINAL OUTCOME” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient reported after 3 months for the final procedure. Post- operative OPG taken shows well osseointegrated dental implants. Hence the final impression was taken and bite trails were seen. A natural looking fixed prosthesis was fixed on the implant. The prosthetic teeth looked very real and well aligned with the patient’s natural teeth, enhancing the patients look and smile. The patient was very happy with the outcome, as it was all that she needed.[/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=”5969″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5970″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5971″ 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=”5972″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5973″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5974″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row][/vc_section]
Cleft Maxillary Advancement Surgery (Le Fort I) with Dental Implant
Patient born with a cleft lip and palate The patient is a 15-year-old boy from Warangal in Telangana, India. He had been born with a unilateral left sided cleft lip and palate at a local hospital. Cleft lip is incomplete fusion of the two halves of the upper lip. A palatal cleft is incomplete fusion of the roof of the mouth. These deformities are the most common congenital deformities. A doctor at the hospital had referred the patient to our hospital. Our hospital is renowned for facial deformity surgery in India. Dr SM Balaji examined the patient and treatment was commenced for the patient. The patient had undergone cleft lip surgery at 3 months of age and cleft palate surgery at 9 months of age. Cleft alveolar reconstruction surgery had been done at 4 years of age with BMP. An anterior crossbite developed as the patient grew up and there was backward positioning of the maxilla. There was also a congenitally missing left upper lateral incisor due to the cleft defect. He had a great deal of difficulty eating because of these defects. His parents brought him back to our hospital for correction of these deformities. The patient became very self conscious of his facial deformity as he grew up and became socially withdrawn. There was a lot of bullying at school and he had very few friends. Bullying by peers is commonly faced by children with cleft lip and palate deformity. This is because they are perceived as being different by other children. Parents of children born with cleft lip and palate are extensively counseled at the time of birth of the children. The first reaction at the birth of a baby with cleft deformities is shock followed by denial. They have to be counseled that full surgical rehabilitation will result in normal development of these children. Initial presentation at our hospital Dr SM Balaji, facial deformity correction surgeon, examined the patient and ordered comprehensive imaging studies. The patient had an increased crossbite in the anterior region. The maxilla was also in a retruded position in relation to the rest of the facial skeleton. There was also a congenitally missing lateral incisor on the left side due to unilateral cleft lip and palate. Treatment planning for addressing the patient’s concerns Presurgical orthodontics was planned to bring the individual teeth in correct alignment before the surgery. Surgical correction would be followed by postsurgical orthodontics for final alignment of the teeth. A Le Fort I surgery was planned to bring out the retrognathic maxilla into correct position. It was also planned to give the patient a dental implant for replacement of the missing maxillary left lateral incisor. Dental implants are the most effective way of replacing missing teeth. Artificial teeth are fixed on the dental implant once osseointegration of the implant is complete. This patient would require an artificial tooth to replace his missing left lateral incisor. Rehabilitation of this patient would be complete at the end of these procedures. The treatment planning was explained in detail to the patient’s parents who agreed to the plan. Presurgical orthodontics was initiated and the patient’s individual teeth were brought into correct alignment. The patient was next scheduled for surgical correction. Surgical correction of the patient’s problems Under general anesthesia, a sulcular incision was made in the maxilla. A mucoperiosteal flap was then elevated to expose the maxillary bone. A Nobel Biocare dental implant was placed in relation to the missing left maxillary lateral incisor. Dental implant surgery was thus completed. This was then followed by Le Fort I bone cuts, which facilitated separation of the maxillary bone. The maxillary segment was then pulled outwards and placed in correct occlusion. This was then stabilized and fixed using titanium plates and screws. The incision was then closed using resorbable sutures. Successful outcome of the surgical procedure The patient and his parents were extremely happy with the results of the surgery. The maxilla was now in correct alignment with the rest of the facial skeleton. Facial esthetics were also very pleasing now. Postsurgical orthodontic alignment would be performed once there was complete consolidation of the bone at the site of surgery. A ceramic prosthesis will be given at the implant after a period of three months once osseointegration of the implant is complete. Surgery Video
Lower Jaw Protrusion ( Prognathism ) Bilateral Sagittal Split Osteotomy (BSSO) Surgery
Correction of lower jaw protrusion Excessive protrusion of lower jaw causes both esthetic as well as functional compromises. It falls under the ambit of facial plastic surgery because of the cosmetic correction. Fixed orthodontic treatment will also be needed to move teeth into correct alignment before the surgery. This tooth movement will lead to optimal results after the surgery. This protocol is followed by the American Association of Oral and Maxillofacial Surgeons. The orthodontic appliances used for this treatment is fixed appliances. Both lower and upper jaw tooth correction is done through this treatment. Metal wires were employed back in the day for this, but modern technology has completely transformed this. Transparent or tooth colored wires are employed nowadays for this treatment. The position of the lower front teeth is most often brought to a vertical orientation for this surgery. The rationale behind this becomes clear after completion of the surgical procedures. Surgery includes backward positioning of the lower jaw in case of mandibular prognathism. The upper jaw position is not altered if the problem is associated only with the lower jaw. Patient with a disproportionately large lower jaw The patient is a 25-year-old male from Palayamkottai in Tamil Nadu, India who has always had problems because of a large lower jaw. This had led to eating and speaking difficulties ever since he can remember. He has difficulty closing his mouth and has had chronic pain in his jaw joints because of this. The patient mentioned that he had a long lower jaw from a very early age. He had gone through depression at multiple stages of life due to his elongated lower jaw. He felt lonely and led a solitary life. His parents had taken him to an oral surgeon at his hometown who had examined him. Realizing the complexity of the problem, the oral surgeon had referred the patient to our hospital for surgical correction of his oversized lower jaw. Our hospital is a renowned center for orthognathic surgery in India. Jaw reconstruction surgery as well as other facial cosmetic surgery procedures are commonly performed in our hospital. What is mandibular prognathism? Prognathism in humans can be due to normal variations among phenotypes. In human populations, prognathism may be a malformation, the result of injury, a disease state or a hereditary condition. This is considered a disorder only if it affects mastication, speech or social function as a byproduct of severely affected aesthetics of the face. Mandibular prognathism is a protrusion of the mandible, affecting the lower third of the face. Pathologic mandibular prognathism is a potentially disfiguring genetic disorder where the lower jaw outgrows the upper, resulting in an extended chin and a crossbite. It is sometimes a result of acromegaly. This condition is sometimes colloquially known as lantern jaw or the Hapsburg jaw. Initial presentation at our hospital for examination Dr SM Balaji, facial cosmetic surgeon, examined the patient and obtained a detailed history. He ordered comprehensive imaging studies for the patient. The patient had an anterior crossbite with class III malocclusion. Treatment planning was presented to the patient and his parents. The patient was advised to undergo corrective lower jaw surgery. This was to be followed by fixed orthodontic treatment for management of his dental malocclusion. Successful surgical correction of the patient’s mandibular prognathism Under general anesthesia, an incision was placed in mandibular retromolar region bilaterally. Flaps were then elevated in the region to expose the mandibular bone. Bone cuts were made and a bilateral sagittal split osteotomy was performed using the Obwegeser technique. The mandible was pushed backwards, occlusion was checked and the mandible was then fixed using Titanium plates and screws. Extreme care was taken to ensure the safety of the inferior alveolar nerve. The nerve in the proximal and distal segments was protected during this part of the procedure. Closure was then done using resorbable sutures. Total patient satisfaction at the outcome of the surgery The patient expressed total satisfaction at the results of the surgery. His facial esthetics was very pleasing and he now had a normal occlusion. His facial profile was also to his liking. He would have to return in a few months to undergo orthodontic treatment. This is for correction of his malaligned teeth. Surgery Video
Cleft Rhinoplasty Alar web Removal and Dorsal Augmentation Surgery
Patient born with unilateral cleft lip and palate The patient is a 19-year-old female from Firozpur in Punjab, India, born with a left-sided unilateral cleft lip and palate. A cleft palate is an incompletely fused roof of the mouth. She had undergone cleft lip repair at 4 months of age and cleft palate repair at 9 months of age. This had been followed by cleft alveolus reconstruction at 4 years of age. All these surgeries had been performed at a local hospital by an oral and maxillofacial surgeon. Surgical correction of these deformities is through oral and maxillofacial surgery. Experienced plastic surgeons also perform this surgery. Perfect alignment of many layers of skin and tissue are involved in this surgery. Surgery for removal of hypertrophic scar tissue might be needed at a later date. Bone grafts will be needed in case of bone deficiency in the alveolar region of the cleft. Speech therapy will be needed for normal development of speech. Normal speech development is very important for proper integration into society. The patient had developed a retruded maxilla as she grew up as well as a nasal deformity. This had made her feel very self conscious and she had always kept to herself with very few friends. She had also faced a lot of bullying at school. Bullying by peers can cause a lot of psychological scars in children with congenital deformity. This is more so in the case of cleft lip and palate as it is on the face. Her worried parents had consulted again with the oral and maxillofacial surgeon who referred them to our hospital. Initial presentation at our hospital in 2018 The patient and her parents initially presented to our hospital in 2018. Dr SM Balaji, rhinoplasty surgeon, had examined the patient and obtained a detailed history. He then ordered for detailed imaging studies, which revealed the retruded maxilla. The patient also had a nose that was depressed on the left side. There was also an ungainly scar with alar webbing on her upper lip from the previous surgery. The patient and her parents wanted correction of the above defects along with creation of a symmetrical nose and scar removal. Treatment planning included Le Fort I correction of her retruded maxilla followed by scar revision surgery of her upper lip. A rhinoplasty surgery was also planned for the nasal deformity correction. She underwent Le Fort I advancement of the maxilla at the time of her initial presentation to our hospital in 2018. She now presents with her parents for rhinoplasty and scar revision surgery. Treatment planning for rhinoplasty and scar revision surgery Examination revealed that the patient had an unsightly scar from her previous cleft lip surgery. There was also a nasal deformity with a depressed left nostril, which was considerably smaller in size than the right nostril. Left nasal sill correction and nose correction with costochondral graft was planned. Alar web correction was also planned on the left side. Surgical correction of the patient’s facial deformities Under general anesthesia, an incision was made in the right inframammary region and a costochondral rib graft was harvested. 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. Following this, a sulcular incision was made in the left anterior maxilla and a flap was elevated. The previously placed titanium plate and screws were removed. Left anterior maxilla was then augmented using the rib graft, which was fixed using titanium screws. Left nasal sill correction was next performed followed by closure of the incision with sutures. A transcartilagenous incision was then placed in the right nostril with dissection up to the dorsum of the nose. The nasal dorsum was augmented using the costochondral graft. A strut graft was then placed. This was followed by closure using resorbable sutures intraorally and intranasally. Successful correction of the patient’s complaints through surgery The patient and her parents were extremely happy with the results of the surgery. There was tremendous improvement in the esthetics of her face. She now had a nose that was symmetrical and in harmony with her face. The patient expressed that she could now face the world with a renewed sense of confidence. Surgery Video
Dental Implants and Ceramic Crowns for Smile Makeover
[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 COMPLAINT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 52 year old female approached our dental hospital, wanting to replace the missing teeth in her upper and lower anteriors. Patient gives a history of extraction of a couple of her upper and lower anteriors done due to severe mobility 5 years back which made it difficult for her to chew food. Since there was space between the front teeth, she was not able to pronounce few words properly, thus hampering her speech. She was worried that her gap would widen more in the future if left untreated. Her inability to have a proper oral function affected her well being. Patient gives a medical history of diabetes for the past 10 years and under medication.[/vc_column_text][vu_heading style=”2″ heading=”EXAMINATION” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, the upper left central incisor, lower central incisors and a couple of her posterior teeth were all missing. The remaining upper and lower anteriors exhibhited grade2 mobility. On radiological examination OPG taken shows generalized bone loss with regard to periodontally week teeth. A thorough blood investigation revealed blood glucose level under control.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]After complete examination of the patient and considering her demand to replace the missing upper and lower anteriors only, Dr.S.M.Balaji planned to extract the shaking teeth and replace it with dental implants under local anesthesia. The procedure was explained to the patient and approval was obtained to go ahead with the treatment plan.[/vc_column_text][vu_heading style=”2″ heading=”PRE- OPERATIVE FOLLOW-UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient was asked to take antibiotics and painkillers for a period of 5 days. Patient was educated and motivated on home oral care regime. The dental implants would take a minimum duration of 3 months to completely osseointegrate with the jaw bone. Until then, a temporary prosthesis was given to the patient to replace the missing teeth.[/vc_column_text][vu_heading style=”2″ heading=”THE FINAL LOOK” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient reported after 4 months. Post-operative x-ray (OPG) taken shows well consolidated dental implants with the jaw bone. Aesthetically natural looking ceramic prosthesis was fixed on to the implants, thus taking off the worrisome days of the patient. The patient was very much pleased with the look. She felt an immediate betterment in her speech. Having been satisfied with the outcome, patient showed keen interest to restore her missing posterior teeth with dental implants at a later date.[/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=”5941″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5942″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5943″ 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=”5944″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5945″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5946″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row][/vc_section]
Cleft Rhinoplasty – Nasal Augmentation and Creating Symmetry
Patient born with right sided cleft lip and palate The patient is an 18-year-old female from Jhansi in Uttar Pradesh, India who was born with a right sided unilateral cleft lip and palate. Cleft lip is the presence of a gap in between the two halves of the upper lip. This is a developmental defect that happens in utero. Repair of cleft lip involves perfect integration of layers of skin and muscle tissues. A cleft palate is incomplete fusion of the roof of the mouth. Cleft palate repair would result in closure of this defect. She had undergone cleft lip surgery at 3 months of age, cleft palate surgery at 8 months of age and cleft alveolus reconstruction at 4 years of age. All these surgeries had been performed by an oral surgeon at a local hospital. Cosmetic and functional complications arising from surgery The patient had developed an asymmetrical depressed nose along with hypertrophic scar from the cleft lip repair surgery. She had faced a lot of bullying in school and had always been a socially withdrawn person with few friends. The patient had become depressed of late and had begun to isolate herself inside the house. Her worried parents visited the oral surgeon who had referred her to our hospital for surgical correction of her deformities. The patient wished to have a symmetrical nose along with removal of the scar from the upper lip. Social difficulties face by children with cleft lip and palate Children born with cleft lip and palate deformity can face a lot of social difficulties. Bullying by peers is one of them. This usually occurs in the school setting. This is a result of these children being perceived as being different by other children. Parents have to be very sensitive and understanding while addressing these issues. Improper handling at this stage can lead to lifelong psychological scarring in these children. Initial presentation at our hospital with treatment planning Dr SM Balaji, cleft rhinoplasty surgeon, examined the patient and ordered comprehensive imaging studies. The patient had a unilateral cleft lip on the right side, which had caused the right side of the nose to become depressed. The right nostril was considerably smaller in size than the left nostril. There was also a noticeable scar near the right nasal sill. Treatment planning of nasal asymmetry and scar revision Rhinoplasty surgery would be required for correction of the nasal asymmetry. A rhinoplasty is also known as the nose job. Correction of the nasal defect was planned through the use of a costochondral graft harvested from the patient. The nasal bridge was to be elevated using the costochondral graft. A strut graft would be used to correct the depressed right nostril. Revision of the scar from the cleft lip repair surgery was also planned for the patient. This was explained to the patient and her parents who consented to surgery. Successful surgical correction of the patient’s complaints Under general anesthesia, an incision was made in the right inframammary region and a costochondral rib graft was harvested. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Scar revision surgery was next performed with the scar near the right nasal sill being excised. A transcartilagenous incision was next placed in the left nostril and dissection done up to the dorsum of the nose. The nasal dorsum was augmented using the costochondral graft. A strut graft was then utilized to elevate the depressed right nostril. Closure was then done using resorbable sutures both intranasally and extraorally. Complete patient satisfaction at the outcome of the surgery The surgery was a success with a resultant symmetrical nose along with excision of the scar from the sill of the nose. Esthetic improvement of the patient’s face was immediate. The patient and her parents expressed complete satisfaction at the outcome of the surgery. The patient now had a more symmetrical nose, which was in harmony with the rest of her face. She expressed her joy and sincere gratitude to the surgeon. She was no longer afraid of fellow students teasing her. She will now be able to lead a normal life with more self-confidence. Surgery Video