Square Face, Masseter Muscle Excision failed – Resurgery with Gonial Angle Reduction
Patient with complaints of a broad lower face due to masseter hypertrophy The patient is a 25-year-old boy from Ranchi in Jharkhand, India. He had always felt very self conscious about his face as he felt that the lower half of his face was very broad. This had made him very self conscious and socially withdrawn over a period of time. He said that he had faced a lot of bullying in school and in college. The patient had presented to a local oral surgeon who had diagnosed him to have hypertrophy of the masseter muscles. The face plays a huge part in day to day interactions. Nobody is truly satisfied with the face that they have, but this does not prevent them from carrying out their activities of daily living. It is only when this dissatisfaction with one’s face crosses a threshold point that it starts to interfere with carrying out one’s daily duties. Plastic surgery initially evolved from general surgery to deal with gross disfigurements of the face. It is only later that it evolved to even correct minor blemishes of the face. Plastic surgery in India has become a highly evolved specialty today. Facial plastic surgeons in India perform a wide variety of cosmetic surgery procedures that range from face lifts to tummy tucks. Reduction of a broad lower face comes under the category of corrective jaw surgery as it involves reduction of the bony excess at the gonial angles of the mandible. Patient not satisfied with results of masseter muscle reduction surgery It had been advised that he undergo masseter muscle reduction surgery (square face surgery) and he had consented for the same. He had undergone masseter reduction surgery through an extraoral approach. This had however failed to remove the masseter muscle and he was not satisfied with the results. There had been an unsightly residual scar. He said that his face still had a square appearance and he felt that it was still esthetically unappealing. His facial profile was not to his satisfaction and he still remained unhappy. He had spoken about his problem with a friend from another city and expressed his lack of self confidence due to this. The friend mentioned that his problem could be easily solved at our hospital. We are a renowned hospital for facial cosmetic surgery in India as well as jaw reconstruction surgery in India. Initial evaluation and treatment planning at our hospital Dr SM Balaji, facial cosmetic surgeon, examined the patient in detail and obtained biometric readings of the patient’s face. He ordered imaging studies including a 3D CT scan of the patient’s facial architecture. The 3D CT scan revealed that the patient had a very broad mandible with prominent gonial angles. This revealed that the patient needed both masseter muscle bulk reduction surgery and trimming and shaping of the gonial angles of his mandible. The findings were discussed in detail with the patient who was in full agreement with the surgical plan and signed the informed consent. Surgical reduction of the gonial angles and masseter bulk Under general anesthesia, modified Wards incisions were placed in the mandibular retromolar regions bilaterally following which flaps were elevated. Dissection was carried down to the gonial angle of the mandible. The gonial angles of the mandible were then reduced bilaterally. This was followed by dissection of the periosteum following which the masseter muscle was identified. The masseter muscle was completely excised bilaterally. Drains were also placed postsurgically in order to ensure that there would be no hematoma formation at the operative site. The wound was checked for hemostasis following which closure was then done using resorbable sutures. Patient very satisfied with the results of the surgery The patient was happy with the outcome of the surgery. He now had a narrower appearing mandible. His facial bulk had also been reduced giving him a more chiseled and sophisticated look. He said that he was very happy with the appearance of his face now. The patient was even more pleased during his subsequent postsurgical follow up visits once the swelling from the surgery had considerably subsided. Surgery Video
31st Indian Society for Dental Research – International Association for Dental Research Annual Conference, Mumbai
[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=”Indian Society for Dental Research” subheading=”” alignment=”left” custom_colors=”” class=””][/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=”1/2″][vc_column_text]The 31st Annual Conference of the Indian Society for Dental Research (IADR-Indian Division) was held recently at the DY Patil School of Dentistry, Navi Mumbai, India. The ISDR is one of the biggest divisions of the International Association of Dental Research (IADR). It is also one of the most active divisions of the IADR and its membership base is one of the largest for any of the IADR subdivisions.[/vc_column_text][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5908″ 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=””][vu_heading style=”2″ heading=”Conference inaugurated by President Rena D’Souza of IADR ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The conference was inaugurated by the IADR President, Prof Rena D’Souza. She was presented with a memento on the occasion by the Governing Council of the Indian Society for Dental Research (ISDR). She spoke about the role played by the ISDR towards enriching the atmosphere for dental research in India. She presented a memento of appreciation to Dr Vijay Patil, Conference Patron who welcomed the distinguished delegates to the conference.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5911″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5912″ 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=”Presentation of annual report by Dr SM Balaji” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr. Christopher Fox, Executive Director, IADR, spoke at length about the goals set by the IADR towards achieving improved oral health and overall general health throughout the world. Prof SM Balaji, Secretary General, ISDR later presented the annual report of the ISDR and spoke about the importance of dental research and the need to foster research in India.[/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=”5913″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5914″ 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=”Release of conference souvenir by the dignitaries” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The conference souvenir release was followed by distribution of the ISDR awards in all categories. The award winners were encouraged to consider research as a full time career in order to help expand the frontiers of scientific knowledge. There was also a hands on course on Advanced Dental Materials at the conference.[/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=”5917″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5918″ img_size=”full”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5919″ img_size=”full”][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vc_column_text]Various certificates were handed over to deserving students for meritorious performances in academics. Dr Namita Shanbhag was awarded the ISDR Fellowship Award.[/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=”5921″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5922″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5923″ img_size=”full”][/vc_column_inner][/vc_row_inner][vc_column_text]Prof SM Balaji, Oral and Maxillofacial Surgeon, presented the annual report of the ISDR at the conference. He also delivered a lecture on Craniofacial Surgery at the conference. His lecture on Advanced Craniofacial Surgery in Dental Practice was very well received by both faculty and students at the conference. He was presented with a memento in appreciation of his lecture at the conference.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5924″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5916″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5925″ 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=”5926″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5927″ img_size=”full”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”Distribution of certificates by Dr SM Balaji to meritorious students” subheading=”” alignment=”left” custom_colors=”” class=””][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_column_text]Prof SM Balaji later presented certificates to meritorious students of the DY Patil School of Dentistry.[/vc_column_text][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5929″ img_size=”full”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Long Lower Jaw BSSO – Bilateral Sagittal Split Osteotomy with Set Back Surgery
Etiology behind the occurrence of mandibular prognathism Mandibular prognathism is the excessive protrusion of the mandible in relation to the rest of the skull. It is considered to be a pathological condition when it compromises both the functional and esthetic aspects of the lower jaw. An extended chin and an anterior crossbite renders both eating and speech difficult for the patient. There can be a genetic element to the occurrence of mandibular prognathism. The house of Hapsburg, which was the royal lineage of Austria had an extreme manifestation of mandibular prognathism because of severe inbreeding that was done to maintain the royal bloodline. There were certain members of the family whose mandibular prognathism was so severe that it made it impossible for them to eat a normal diet. The functional problems caused by mandibular prognathism can lead to severe limitations in jaw function. Corrective jaw surgery is performed to set right the functional problems. This is also a cosmetic surgery as it leads to an improvement in facial esthetics for the patient. The open bite and the cross bite are also corrected by this surgery. Bilateral sagittal split osteotomy, which is the surgery performed for correction of mandibular prognathism is performed by oral and maxillofacial surgeons. Other surgical procedures performed by them include TMJ surgery. Problems arising from a long lower jaw The patient is a 25-year-old female from Indore in Madhya Pradesh, India who had always had a long lower jaw in relation to her upper jaw. She also had a degree of facial asymmetry arising from this condition. There were also issues with difficulty with speech and eating. She was also unable to close her lips fully. This was resulting in dry chapped lips. Her parents had decided to seek medical attention to correct this problem. They had approached a local orthopedic surgeon who had examined the patient. He explained to the patient and her parents that she needed to be operated on by an Oral and Maxillofacial Surgeon. He had referred them to our hospital as we are one of the premier centers for jaw reduction surgery in India. Our hospital addresses every cosmetic surgical need that arises from the facial region including rhinoplasty surgery, microtia surgery, ptosis surgery, facial reanimation surgery, facial reconstruction surgery and all varieties of jaw surgeries including cyst removal surgery, TMJ joint surgery, and jaw reconstruction surgery. Incidence rates of facial asymmetry in the general population Among the overall population, facial asymmetry can either be noted clinically or subclinically. It not only causes esthetic compromise, but also affects functionality. Facial asymmetry can due to many etiological factors. These can broadly be divided into congenital or acquired. The treatment plan for facial asymmetry depends on age, severity and etiology. Treatment planning is arrived at by carefully assessing the results of the intraoral, extraoral and radiological examinations. Initial presentation and treatment planning at our hospital Dr SM Balaji, jaw reconstruction surgeon, examined the patient thoroughly and ordered radiological studies. The patient had an anterior crossbite with class III malocclusion. Various model studies were performed following which Dr SM Balaji advised them that she best undergo lower jaw reduction followed by fixed orthodontic therapy for management of her malocclusion. The patient and her parents were in agreement with the treatment plan and signed the consent form. Successful surgical reduction of her increased mandibular length Under general anesthesia, incisions were placed in the mandibular retromolar regions bilaterally following which flaps were elevated. This was followed by bone cuts being made and bilateral sagittal split osteotomy performed. Extreme care was taken at this stage to ensure that there was no iatrogenic damage to the inferior alveolar nerve. It was mobilized with the distal segment so that the proximal segment could be adequately mobilized for the bilateral sagittal split osteotomy. The mandible was then pushed backward, checked for occlusion and fixed using Titanium plates and screws. This was followed by closure using resorbable sutures. Total patient satisfaction at the results of the surgery The patient was very happy with the outcome of the surgery. Her occlusion was completely normal and her maxillary teeth and mandibular teeth were in good alignment with a normal occlusion. Her facial profile was also corrected. She will still need to undergo fixed orthodontic treatment to correct the individual malalignment in each tooth. The patient was advised to return for this in a few months. Surgery Video
Refracturing the malunited jaw, correcting the occlusion and upper jaw augmentation surgery
Evolution of Facial Fracture Treatment down the ages We live in the golden age of mankind where wars are minimal and the frontiers of medical science are being expanded on a daily basis. The fields of oral surgery and orthognathic surgery have become highly advanced, both in the form of techniques and the materials used. Medical treatment was very primitive in the ancient days. Mankind too led far more violent lives and the occurrence of facial fractures was quite common. This left behind debilitating deformities of the face. There was also partial loss of dentition when the fractures involved the bones of the jaws. This led to a great drop in the quality of life of the person. Functional problems directly contributed to a reduction in the lifespan of the individual. Common sites of occurrence of facial fractures Common fractures that occurred included orbital fractures, fractures of the sides of the face, nasal fractures and broken bones involving the eye sockets. This led to an asymmetrical face with soft tissue distortion. Facial features became distorted leading to social problems. The advent of reconstructive surgery and corrective jaw surgery in modern times greatly helped in the treatment of facial fractures. Modern surgical practices utilize titanium screws and plates to correctly align and stabilize the fractured segments in normal anatomical alignment. Implants are used to replace any lost teeth. An implant mimics a tooth root. Artificial teeth are fixed on top of these implants to rehabilitate the patient. Straightforward implant surgery is a simple procedure and can be performed under local anesthesia. This not only results in improved oral health but also improved general health. Bone grafting is utilized when there is loss of bony support for fixing implants. Care should be taken during the healing process to ensure best long term viability of the implants. Patient with a history of multiple fractures from a road traffic accident The patient is a 32-year-old female from Kurnool in Andhra Pradesh, India who had been involved in a horrific road traffic accident around five years ago. This had resulted in panfacial fractures for the patient. She had been admitted at a local hospital for fracture reduction and plate fixation. However, she had never been happy with the outcome of the facial fracture surgery as it had resulted in a facial asymmetry. The fractured segments of her mandible had collapsed inwards and there was also a deficit of 8-10 mm of bone at the fracture site. In fact, this had slowly developed into a depression with her avoiding all social contact. She also had functional jaw problems, which made it difficult for her to eat well. A family friend from Chennai had visited her in Kurnool and had come to know about her problems. She had then referred the patient to Balaji Dental and Craniofacial Hospital in Chennai. The patient and her husband thus presented to our hospital for surgical correction of her malunited fracture. Our hospital is a renowned center for jaw deformity surgery in India. Initial examination and treatment planning in our hospital Dr SM Balaji, facial asymmetry surgeon, examined the patient and ordered radiographic studies. Clinical examination revealed that the patient had partially edentulous maxilla and mandible. The right maxillary and mandibular ridges were not in alignment and were also not suitable for teeth replacement. There was notable facial asymmetry in the lower part of the face. A 3DCT scan revealed malunited mandible. The patient also did not have sufficient bone in the right maxilla for replacement of her missing teeth. The treatment plan was to refractured the mandible and fix it in proper alignment using plates and screws. The right maxillary alveolar ridge was to be reconstructed using the rib graft. Surgical correction of the malunited fracture through refractured of the jaw Under general anesthesia, rib grafts were first harvested from the patient. Following this, 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. Next, a crevicular incision was placed in mandible and a mucoperiosteal flap was elevated. Dissection was then done down to the previously placed titanium plates and screws, which were then removed. Following this, the mandible was refractured along the midline, checked and separated by about 8-10 mm at the midline. This gap was closed using pieces of rib graft. The segments were then stabilized and fixed in the new position using titanium plates and screws. A midcrestal incision was next placed in right maxilla and a mucoperiosteal flap was elevated. The previously placed plates and screws removed. The right maxillary alveolar ridge was augmented using rib graft and fixed with screws. Hemostasis was achieved and closure was done using resorbable sutures. Successful outcome of the surgery The patient was very happy with the outcome of the surgery. Her facial asymmetry was completely corrected and the right maxillary and mandibular alveolar ridges were in perfect alignment. The patient can undergo dental implant surgery after about 3-4 months following complete bone formation. She expressed her total satisfaction at the outcome of the surgery. Surgery Video
Oral Submucous Fibrosis – partial Trismus Mouth Opening Surgery With Nasolabial Flap Surgery
The growth of aesthetic surgery in India Cosmetic surgery or plastic surgery in India has become highly sought after since the advent of globalization. Some of the common procedures performed include brow lift eyelid surgery, face lifts, correction of congenital defects, reconstructive surgery for trauma victims etc. There has been a mushrooming of plastic surgery hospitals in India of late. Patients who wish to opt for cosmetic procedures have to be very cautious in choosing the right hospital. There have been many instances where the results of the surgery have been catastrophic for the patient. This necessitates corrective surgery at the hands of an experienced surgeon. Therefore, patients have to be very cautious in the selection of the surgeon as well as the hospital. Young man with progressively worsening mouth opening The patient is a 19-year-old male from Kashipur in Manipur, India who began noticing a tightness while opening his mouth from around two years ago. This was slowly getting worse with the passage of time. It has now reached a point where he is able to opening his mouth by only around 7 mm. This has made eating very difficult and he noticed that his cheeks had also started hardening. The patient has been chewing khaini, a mixture of tobacco, lime and betel nut since he was 12 years old. He however does not smoke cigarettes or drink alcohol. Patient decides to seek medical attention for his mouth opening problems It ultimately reached the point that the patient decided to seek medical attention for his problem. An oral and maxillofacial surgeon in his hometown examined him and informed him that he had submucous fibrosis. He also informed the patient that this had been brought about by his tobacco habit and advised the patient to quit his habit immediately. The patient was also informed that treatment for submucous fibrosis was mainly surgical and that only a few specialty hospitals in India performed this surgery. He then referred the patient to our hospital for management of his submucous fibrosis as our hospital is renowned for oral submucous fibrosis surgery. Our hospital is also renowned for a variety of facial cosmetic surgery in India. What is oral submucous fibrosis? Oral submucous fibrosis is a chronic, complex, premalignant (1% transformation risk) condition of the oral cavity, characterized by progressive fibrosis of the submucosal tissues. As the disease progresses, the jaws become rigid to the point that the person is unable to open the mouth. The condition is remotely linked to oral cancers and is associated with areca nut or betel quid chewing. This is a habit that is practiced predominantly in SouthEast Asia and India and is similar to tobacco chewing. Once oral submucosal fibrosis has set in, it cannot be reversed and treatment mainly consists of management with steroids and surgery. Initial presentation at our hospital for management of oral submucous fibrosis Dr SM Balaji, oral submucous fibrosis surgeon, examined the patient. Various measurements were obtained from the patient’s mouth. The patient had a mouth opening of about 7mm. Clinical examination revealed thick fibrous bands on the buccal mucosa bilaterally. He was diagnosed with oral submucous fibrosis. The patient’s condition was explained to him in detail. Surgical planning to for excising the fibrous bands followed by covering the raw area with nasolabial flap was also discussed with the patient. The patient was in agreement with the treatment plan and signed the consent form. Surgical treatment of the patient’s oral submucous fibrosis The patient underwent awake bronchoscopic intubation as the patient was not able to open his mouth adequately for normal intubation. Following successful intubation, the incisions were marked out on the skin along natural skin creases to minimize visible scar formation. Following this, a linear horizontal incision was made in the buccal mucosa bilaterally and the fibrous bands were excised. This was followed by placement of an elliptical incision in the nasolabial region bilaterally and an inferiorly based nasolabial flap was elevated. Blood supply to the flap was through the facial artery. Care was taken at all times to ensure that blood supply was not compromised. Tunneling was then done and the flap was rotated Intraorally and sutured to the buccal mucosa using resorbable sutures. A mouth opening of about 3.2 cm was achieved through this procedure. Successful outcome to the surgical intervention The outcome of the surgery was as planned. Adequate mouth opening was achieved postsurgically. The patient was advised to do mouth opening exercises to further improve his mouth opening. There was hardly any noticeable scar on the nasolabial region at the patient’s one month follow up appointment. Surgery Video
Facial Asymmetry Correction by BSSO Bilateral Sagittal Split Osteotomy and total shift of Mandible (Lower Jaw) Surgery
The patient is a 22-year-old female patient from Gwalior in Madhya Pradesh, India who has always had the complaint of facial asymmetry. She had an anterior crossbite with jaw deviation to the left upon mouth opening.
Facial Asymmetry Surgery BSSO Bilateral Sagittal Split osteotomy with Total Lower Jaw Shift
Patient with lower jaw problems for a long time The patient is a 19-year-old boy from Malkajgiri in Telangana, India who has had jaw problems as long as he can remember. His lower jaw was longer than his upper jaw and had been deviated to the left side with a resultant crossbite. This had detracted not only from the esthetics of his face, but has also caused him difficulties with speech and eating. Social interactions have always been a difficult area for the patient because of this. The patient stated that he has no history of any injury to his jaw region that could have resulted in this. Of note, interestingly, the patient’s brother as well as father also had mandibular prognathism for which they underwent surgery with full resolution of the problem. Patient desires to undergo corrective jaw surgery He complained to his parents that he wanted this corrected as it was getting to be extremely difficult to handle this with the passage of years. His parents too felt that this needed to be addressed and they visited a local oral surgeon who had examined the patient thoroughly and obtained comprehensive imaging studies. He explained that the patient needed corrective jaw surgery followed by fixed orthodontic therapy to correct the malaligned teeth. The oral surgeon further advised that this surgery was a complex procedure and said that only a few specialty centers in India performed this. He therefore referred the patient to our hospital, which is a premier center for jaw correction surgery in India. We are also renowned for orthognathic surgery in India. What is the meaning of mandibular prognathism? Mandibular prognathism is a positional relationship of the mandible or maxilla to the skeletal base where the lower jaw protrudes beyond the upper jaw, thereby leading to malocclusion. The word prognathism derives from the Greek πρό (pro, meaning “forward”) and γνάθος (gnáthos, “jaw”). One or more types of prognathism can result in the common condition of malocclusion, in which an individual’s top teeth and lower teeth are not aligned properly. Correction of this condition is through both surgery as well as fixed orthodontics Initial presentation and examination at our hospital Dr SM Balaji, facial asymmetry surgeon, examined the patient and obtained comprehensive imaging studies. This revealed that the mandible was deviated to the left side with a crossbite. It was advised that the patient undergo lower jaw correction surgery for correction of his facial asymmetry. He was further advised to undergo orthodontic treatment for management of his dental malocclusion. The patient and his parents were in agreement with the proposed plan of treatment and consented to the surgery. Our hospital strictly adheres to the protocols laid by the American Association of Oral and Maxillofacial Surgeons with regards to performance of all surgical procedures. Facial asymmetry surgery is a procedure that not only requires a high degree of surgical skill, but also requires an eye for esthetics on the surgeon’s part. The two halves of the face have to be perfectly balanced in order to produce true facial harmony and ideal esthetics. Long term stability of the results can be ensured by strict adherence to these protocols. Surgical correction of the patient’s jaw deviation Under general anesthesia, eyelets were first placed in both jaws. Following this, incisions were placed in the mandibular retromolar region bilaterally. Flaps were elevated, bone cuts were made and bilateral sagittal split osteotomy done. The mandible was rotated to the right side and pushed backward so that correct occlusion was achieved along with complete correction of the facial asymmetry. It was then fixed in the new position using titanium plates and screws. Closure of the two incisions was then performed using resorbable sutures. Full patient satisfaction at the outcome of the surgery The outcome of the surgery was immediate and the patient was very happy with the results. He now had a completely normal occlusion and his facial asymmetry had also been corrected. He said that he would now have the confidence to face the outside world bravely. Orthodontic treatment would be performed at a later time for correction of his malaligned teeth. Surgery Video
Complete Trismus total inability to open the mouth due to OSMF – Oral Submucous Fibrosis – Nasolabial Flap Surgery
The patient is a 65-year-old man from Patna in Bihar, India who has been noticing a gradual tightening of the facial structures involving his cheek and oral mucosa over the past six years. It has reached the point where he is able to open his mouth only minimally. The soft tissues had become very fibrous and hardened. He has been having difficulty with speech and eating since that time. There was also a burning sensation to his cheek whenever he ate even minimally hot and spicy food. He had been neglecting this since the time he first noticed this.
TMJ Ankylosis Surgery – Growth Center Transplantation – CC Graft Surgery
The patient is a now 13-year-old boy from Gudur in Telangana, India who had fallen down on his chin as a child. His parents…
Removal of Calcifications in the masseter muscle surgery
This patient is a 28-year-old male from Alapuzha in Kerala, India who started noticing a mild swelling and pain in his left lower face for the past 6-8 months.