Blog - Balaji Dental and Craniofacial Hospital

June 20th, 2019 08:06 pm June 20, 2019

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.

June 18th, 2019 09:17 pm June 18, 2019

smbalajiSurgery 331

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...

June 16th, 2019 06:23 pm June 16, 2019

smbalajiSurgery 331

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.

June 15th, 2019 07:36 pm June 15, 2019

smbalajiSurgery 331

Large Dentigerous Cyst, Multiple times operated Resurgery, Reconstruction with Rib Graft

The patient is a 28-year-old male from Gurdaspur in Punjab, India. He began noticing the development of...

June 12th, 2019 08:33 pm June 12, 2019

smbalajiSurgery 331

Hemifacial Microsomia total Absence of Ramus and Condyle Reconstruction with costochondral graft

Patient born with hemifacial microsomia The patient is a 7-year-old female from Gorakhpur in Uttar Pradesh, India. She had been born with the absence of a left ramus and condyle of the mandible. The patient also had microtia along with absence of a left orbital globe. The asymmetry of her face worsened as she grew up. She was getting more and more depressed with the passage of time and was facing a lot of bullying at school. This worsened to the point where she refused to go to school. She had already undergone placement of an eye prosthesis to replace her missing left orbit. Her worried parents met with a local oral surgeon to seek advice regarding correction of her condition. The surgeon explained the complexity of treatment involved in the correction of hemifacial microsomia to the parents. He said that hemifacial microsomia surgery was performed only in a few specialty hospitals in India. The surgeon then referred them to our hospital for facial asymmetry correction surgery. Our hospital is one of the premier centers for facial cosmetic surgery in India. We are also one of the leading oral and maxillofacial surgery hospitals in India. Dr SM Balaji, our director, is a top cosmetic surgeon in India. Board certified oral and maxillofacial surgeons perform this surgery in the developed countries. A brief introduction into hemifacial microsomia Hemifacial microsomia (HFM) is a congenital disorder that predominantly affects the development of the lower half of the face. It most commonly affects the ears, the mouth, and the mandible. It usually occurs on one side of the face through it may rarely involve both sides. If severe, it may result in breathing difficulties due to obstruction of the trachea—sometimes even requiring a tracheotomy. It is the second most common birth defect of the face after cleft lip and cleft palate. Hemifacial microsomia shares many similarities with Treacher Collins syndrome, Franceschetti syndrome etc. Patients with hemifacial microsomia exhibit varying degrees of facial asymmetry. It can range from very mild to very severe. Correction of the facial asymmetry is very important for patients to gain self confidence to become productive members of society. One of the aims of this surgery is to establish as much facial symmetry as possible. Once correction of the ramus and body has been completed, soft tissue molding leads to better symmetry of the face. Plastic surgery in India has become a highly evolved field now. Reconstructive surgery performed by plastic surgeons deal with a wide variety of surgical procedures. Facial implants are also used to help in establishing better symmetry. Initial examination upon presentation at our hospital Dr SM Balaji, hemifacial microsomia surgeon, examined the patient thoroughly following which he then ordered comprehensive imaging studies including a 3D CT. Imaging studies revealed that there was absence of condyle and coronoid on the left side along with the presence of a hypoplastic ramus. This had resulted in the development of a considerable occlusal cant. The patient also had microtia on the left side. Correction of this defect was advised to be carried out at around the age of 14 years old. It was explained to the patient that she would need to undergo a ramus distraction osteogenesis for correction of her facial asymmetry. However, there was insufficient bone present to perform a successful distraction osteogenesis. Therefore, a costochondral rib graft would be harvested to create a condyle and reinforce the ramus, thus creating sufficient bone for distraction surgery Surgical augmentation of hypoplastic left mandible for distraction surgery Under general anesthesia, a right inframammary incision was first made and a costochondral rib graft was harvested through the opening. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The wound was then closed in layers. Following this, a left submandibular incision was placed and dissection was performed up to the condyle. The coronoid process was then created and the ramus augmented using a costochondral rib graft, which was fixed in place using titanium screws. Closure was then done using resorbable sutures. Happy patient after successful outcome of the surgery The surgery was a complete success. The coronoid was successfully created and ramus was augmented. A follow up OPG taken three months postoperatively revealed that there was sufficient bony consolidation in the area of the surgery. The patient also had a more symmetrical face. Distraction osteogenesis surgery will be performed after a period of about six months followed by ear reconstruction after attaining sufficient growth. Surgery Video frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="">

June 10th, 2019 09:36 pm June 10, 2019

smbalajiSurgery 331

Fixed Zirconia Bridge for Broken Teeth

[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 HISTORY” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text] A 19 year old male approached our dental hospital, seeking for correction of his broken upper front teeth. Patient gives a history of traumatic fall 10 days ago, which has broken a part of the tooth structure in the upper front teeth. Patient complained of severe sensitivity of the teeth at the relative site. Even the contact of slightest air on the teeth induced sensitivity. The patient had tried using de-sensitizing toothpaste for a week and stated that it didn’t make his condition any better. Moreover, he felt that the broken anterior teeth looked aesthetically unpleasant. He felt insecure to speak confidently and smile for photos. [/vc_column_text][vu_heading style=”2″ heading=”PATIENT EXAMINATION” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text] On clinical examination, there was no pain on palpation. There was no sign of mobility or discolouration of the broken teeth. The gum tissue surrounding the relative teeth had no abnormality. On radiological examination, it was evident that a portion of the front teeth were broken exposing the structure called Dentin (yellowish structure which lies beneath the enamel of the tooth). No crack line was seen on the root of the tooth. No pathological findings in the surrounding bone structure. “Dentin consists of a sensitive layer of tissue that communicates with the nerve of your teeth. When dentin becomes exposed, things that never hurt your teeth before may also feel very painful”. [/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text] First choice of treatment of restoration of the broken upper anteriors with tooth coloured filling material was suggested to the patient with its pros and cons. Patient was asked not to bite anything with the front teeth after the treatment, as the restoration is more likely to chip off. This concerned the patient. As he was young and aesthetically concerned, he demanded for an alternative option. Considering the patients age and demand and in order to treat hypersensitivity, our highly skilled Endodontist ( dentist specialized in restoration and root canal treatment of the teeth), under the guidance of Dr.S.M.Balaji, planned to perform root canal treatment of the affected anterior teeth under local anesthesia followed by placement of a fixed ceramic/ Zirconia bridge. The dental procedure was clearly explained to the patient. Patient opted for Zirconia as it provides more natural appearance and durability. Consent was obtained. [/vc_column_text][vu_heading style=”2″ heading=”Root canal treatment” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text] Root canal is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The procedure involves removing the nerve tissue of the affected tooth (the pulp), cleaning and disinfecting it, then filling and sealing it. [/vc_column_text][vu_heading style=”2″ heading=”DENTAL PROCEDURE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text] In the first visit, under local anesthesia, root canal procedure was carried out for the broken upper anteriors. An access hole was drilled at the back of the teeth. The nerve tissue (pulp) of the teeth is taken out followed by cleaning and disinfecting of the root canals. Saline medium is used periodically to flush away the debris. Thorough cleaning and shaping of the root canal was achieved. The exterior hole in the tooth was sealed with a temporary material to keep out contaminants like saliva and food between appointments. The patient was asked to report after 3 days. In the second visit, temporary restoration was removed. Finally the root canals are filled with a permanent restorative material called “guttapercha” and sealed with a medicated paste. Followed by root canal treatment, crown preparation of the anterior teeth was done. Restoring teeth to good form and function requires preparation of the teeth for placement of the dental restorations (crown or bridge). The process of preparation usually involves grinding of the teeth with special dental burs, until the desired shape and size is achieved, to make space for the ceramic bridge. Then the impression of the teeth in the upper and lower jaw are taken, so the permanent crown can be made accordingly. The patient was given a new temporary dental bridge that protects the tooth until the final crown is ready to be permanently placed. [/vc_column_text][vu_heading style=”2″ heading=”THE CONFIDENT PATIENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text] After a couple of days, the temporary bridge was removed. Aesthetically pleasant looking fixed ceramic bridge was positioned and fixed on to the teeth with special adhesive cement. The dental bridge looked real and matched the natural colour of his teeth. Patient was very pleased with the outcome and he walked out with a dazzling smile confidently. [/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=”5844″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5845″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5846″ 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=”5847″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5848″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5849″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row]

June 9th, 2019 06:06 pm June 9, 2019

smbalajiDental Implant 14

Zygoma implants for Atrophic upper jaw

[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] PATIENT HISTORY A 60 year old female patient approached our dental hospital with a complaint of mobile prosthesis in her upper and lower jaw. Patient had a history of long standing mobile teeth due to debilitating periodontal pathology, following which she had undergone extraction of all her teeth. The patient said that she remained without teeth for a period of 2years. Later she had replaced her missing teeth with an implant-supported prosthesis done elsewhere. Patient stated that the prosthesis had been fixed in just a week after the implant placement. Within one month of having the prosthesis fixed, she started to experience pain and discomfort in the gum tissue surrounding the prosthesis in both upper and lower jaws. Subsequently, the prosthesis exhibited mobility. Also she grumbled upon the salty tasting liquid discharge from her gums. Due to the above reasons the patient was struggling to chew food. She was very upset with her oral health. She worried that the mobility would progress more if left untreated. She was desperate to get rid of the shaking prosthesis. Patient had no history of diabetes mellitus or any other adverse habits. EXAMINATION On clinical examination, the gums surrounding the implant prosthesis were swollen and tender on palpation. There was evident pus discharge and bleeding on examination. The implants in the upper and lower jaw exhibited mild mobility depicting a condition called ‘peri-implantitis’. “Peri-implantitis is an infection of the soft and hard tissues surrounding an osseointegrated implant, leading to the loss of supporting bone.” Pre-operative x-ray taken shows diffuse radiolucency around the implants in the upper and lower jaws indicating severe bone loss, owing to the mobility of the implants. TREATMENT PLAN On view of the patient’s condition and insistence of the patient, Dr. SM Balaji planned to remove the failed dental implants along with the prosthesis under local anesthesia, to relieve the patient from suffering further. Followed by replacement of missing teeth with removable denture. TREATMENT STAGE I Under local anesthesia the prosthesis in the upper and lower jaws were removed along with the infected dental implants. Patient was put on antibiotics to decrease the infection and to aid the healing of the gum tissues. Later Impression was taken and removable upper and lower dentures were delivered to the patient to replace her missing teeth temporarily. STAGE I REVIEW The patient returned after 4 months for review. The patient stated that she was not able to relish her meals, as the upper denture covered the palate. Although patient was managing with the removable dentures, she was insisting for a fixed option by which we could replace her missing teeth. OPG taken shows insufficient bone height in the upper posterior region, to support the conventional dental implant. With regard to the patient’s oral condition and need, Dr.S.M.Balaji decided to perform a graft less technique under general anesthesia, by anchoring the upper posterior dental implants in the zygomatic bone (cheek bone) and with additional conventional dental implants where there is sufficient bone, under general anesthesia thereby providing a brilliant alternative for teeth replacement. ZYGOMA IMPLANT For severe bone resorption, zygomatic implants are excellent treatment of choice, as it would shorten time and lengthy treatment procedure involved in bone grafting techniques. Zygoma bone provides great stability and retention for the dental implant. It aids in high primary stability for immediate function. The surgical procedure was clearly explained to the patient and consent was obtained. STAGE II TREATMENT Under general anesthesia, the gum tissue is cut and elevated in the upper and lower jaw bone exposing the underlying bone. Followed by this a small oval window is cut open in the right upper lateral wall of the sinus close to the zygomatic bone (cheek bone). A membrane is exposed on the other side of the bone which acts as a barrier between the sinus and the jaw. This membrane is then gently lifted away from the area creating a space through which the zygoma implant is placed. The zygoma implant is drilled with precision, ensuring not to penetrate the membrane. Similarly, the zygoma implant was fixed in the left upper posterior region. In addition to this, conventional implants of varying height and depth were placed in the anterior region of the upper jaw and lower jaw. POST-SURGICAL PROTOCOL The patient was put on medication for 5 days to cope up with the mild pain and discomfort. Home care instructions were given. Patient was asked to report after 6 months for final prosthesis. This duration is for the dental implants to completely osseointegrate with the jaw bone. Meanwhile, patient was given a light weight provisional prosthesis. THE HAPPY PATIENT Patient reported after 6 months. Post-operative OPG taken shows zygomatic implants and conventional implants, well integrated and positioned in the jaw bone. Final impression was taken. After a couple of bite trials ensuring no traumatic bite, natural looking fixed hybrid prosthesis was fixed onto the dental implants. There was an immediate remarkable change in the patient’s speech and appearance which boosted her confidence. The patient and her family members were very happy with the outcome. Patient is on a regular follow up. [/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=”5824″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5825″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5827″ 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=”5829″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5833″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5831″ 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=”5828″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5830″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column][/vc_row]

June 8th, 2019 07:58 pm June 8, 2019

smbalajiSurgery 331

Square Face, Masseter Muscle Excision failed – Resurgery with Gonial Angle Reduction

Facial cosmetic surgery and the reasons people opt for it Every one of us desires to have a face that is esthetically appealing and attractive to others. Just like every man would desire to have a prominent jaw with a masculine jawline, every woman desires to have a dainty feminine jaw shape. Masseter muscle hypertrophy is a condition where the masseter muscle becomes greatly increased in size. The masseter muscle is the muscle at the angle of the jaw and is one of the most important muscles of mastication. When this muscle becomes hypertrophied, it leads to the creation of a strong masculine jaw line and profile. Women who manifest this condition opt for plastic surgery to get this corrected. This is one of the many facial feminization procedures available today. Patient safety is fully assured from this surgery and there are no undesirable side effects when performed by a competent oral and maxillofacial surgeon or a board certified plastic surgeon. The facial features are softened by this procedure and the feminine quotient of the face is increased. This enables the patient to gain more self confidence and a sense of social acceptance that will enable her to better integrate into the social structure and not feel self conscious about having a broad masculine face. The results often influence the patient’s life to such a degree that it improves the quality of life for the patient right across the board. Patient undergoes masseter muscle reduction in her hometown The patient is a 25-year-old woman from Parbhani in Maharashtra, India. She had always felt that her lower face was very broad and square shaped. She disliked this a great deal and said that this made her look very masculine. She had always wanted to change this. Her parents had approached a plastic surgeon in their hometown about a year ago who had referred them to an oral surgeon. After a thorough examination, the oral surgeon had explained to them that the increased breadth of the lower face was due to hypertrophy of the masseter muscle at the angle of the mandible and had recommended masseter muscle reduction surgery. Patient not satisfied with the results of the master muscle reduction surgery The patient had undergone masseter muscle reduction, but still was unhappy with the appearance of her face. She felt that her facial structure had not become feminine even after the surgery. They had subsequently approached the plastic surgeon again who then referred them to our hospital as we are renowned for facial cosmetic surgery in India. Jaw reduction surgery and jaw reconstruction surgery is routinely performed in our hospital. Presentation and treatment planning at our hospital The patient and her parents thus presented to our hospital for management of her complaint. Dr SM Balaji, facial cosmetic surgeon, examined the patient clinically and obtained radiological studies of the patient’s face. Though clinical examination suggested masseter muscle hypertrophy, the 3D CT scan revealed that the patient had a very broad mandibular structure as well as prominent masseter muscles bilaterally. It was explained to the patient and her parents that masseter muscle reduction alone would not be enough to correct the patient’s problem and that bony reduction of the mandibular angles also needed to be performed bilaterally. The patient and her parents were in agreement with this treatment plan and consented to the surgical procedure. Successful surgical reduction of the patient’s lower facial breadth Under general anesthesia, a modified Ward’s incision was made bilaterally in the mandibular retromolar area. This was followed by elevation of bilateral flaps in the region to expose the gonial angle of the mandible. The gonial angle of the mandible was then carefully reduced to the right size bilaterally using a round bur. This was followed by dissection of the periosteum with identification of the masseter muscle. The masseter muscle was then partially excised with reduction of bulk bilaterally. A drain was placed at the operative site postsurgically to prevent formation of any hematoma in the region. Closure of bilateral incisions was then done using resorbable sutures. Patient and her parents express their satisfaction at the results of the surgery The patient was extremely happy with the results of the surgery. She now had a very feminine mandible without the excessive bulk. Her parents were also very happy with the results of the surgery and said that this would help the patient gain more confidence in life. Surgery Video

June 6th, 2019 06:19 pm June 6, 2019

smbalajiSurgery 331

Lower Jaw Tori Removal Surgery

Patient begins to notice bony outgrowths in his mandible The patient is a 33-year-old patient from Bagdogra in West Bengal, India who said that he had always had small bony protrusions on the inner side of his lower jaw ever since he could remember. He however said that he was never worried about it as it had never caused him pain or any sort of discomfort. It said that it was only recently that he had felt the need to get them removed and had approached a local oral surgeon in his hometown. The surgeon had examined him thoroughly and also obtained radiological studies, which revealed multiple small bony prominences on the lingual aspect of the lower jaw. The patient was then informed that he had multiple mandibular tori. When the patient expressed his desire to have them removed, the surgeon referred him to our hospital for tori removal surgery as our hospital is renowned for jaw reduction surgery in India. Our hospital rigorously follows all key surgical protocols laid out by the American Association of Oral and Maxillofacial Surgeons. Orthognathic surgery is another specialty surgery that our hospital is very famous for. Corrective jaw surgery and cosmetic surgery often overlap when it comes to correction of facial asymmetry that is caused by jaw deformities. Surgery is performed only after meticulous surgical planning has been carried out. Torus mandibularis, their occurrence and etiology behind tori formation Torus mandibularis is the formation of bony growths in the mandible along the surface nearest to the tongue. Mandibular tori are usually present near the premolars and above the location of the attachment of the mylohyoid muscle to the mandible. In more than 90% of the cases, occurrence of the torus is bilateral, making the presence of a unilateral torus a very rare finding. Dental professionals usually are the first to identify the presence of mandibular tori unless they are extremely large and interfere with functioning. As the name suggests, tori are never found on the roof of the mouth. They never involve the upper jaw and are always found on the inner aspect of the mandible. The bone of the tori can often be harvested to be used for bone grafting. This makes for an ideal bone grafts material as it is harvested from the patient’s own body thus completely negating any chances of graft reduction. The rate of occurrence of mandibular tori ranges from 5-40% of the population. They are usually very small and do not cause any inconvenience to the patient. The formation of mandibular tori could be due to several factors. They are more common in early adult life and are frequently found in patients with bruxism. The size of the tori may fluctuate throughout life. In rare instances, the tori can be large enough to touch each other in the midline of the mouth. Consequently, it is believed that the development of mandibular tori can also result from local factors and are not solely due to genetic influences. Initial presentation at our hospital for management of his tori Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained radiological studies. He explained to the patient that he had mandibular tori as diagnosed by the oral surgeon in his hometown. It was further explained to the patient that removal was not mandatory if they were not causing any problems. The patient however was insistent that he wanted them removed. The surgical procedure was explained to the procedure who consented to surgery and signed the surgical consent to undergo removal of mandibular tori. Successful surgical removal of the patient’s mandibular tori Following successful induction of general anesthesia, a crevicular incision was placed in the lingual aspect of the mandible, which was followed by elevation of a mucoperiosteal flap. The mandibular tori were then exposed and subsequently reduced with the help of a round bur. The bony prominences were made flush with the surrounding bone. Closure of the incision was then done using resorbable sutures. Patient expresses satisfaction at the results of the surgery The patient was extremely happy with the results of the surgery and said that he would now return to his hometown in a peaceful state of mind.

June 2nd, 2019 03:47 pm June 2, 2019

smbalajiSurgery 331

Crouzon Syndrome Le Fort III Advancement with Kawamoto’s Distraction

Genetic transmission of disorders in human beings Genes are a form of code used by living cells to guide developmental pathways in living organisms. The sequence of the code in the DNA is very important for the normal development of all forms of life. They are transferred from one generation to another and contain information that is vital for the normal development of the organisms. Mutations are changes in the sequence of the code contained in genes. Mutations can either be beneficial or harmful. Evolution of living organisms through the ages has been enabled by beneficial mutations. These help species adapt to their changing environment. An example of this adaptation is the quality of air millions of years ago and the quality of the air we breathe now. Oxygen content in the air millions of years ago was much higher than what it is now. If this air was to be breathed by organisms living today, it would prove lethal to all forms of life. The gradual adaptation of life to lowered oxygen levels has been enabled by beneficial genetic mutations down the ages. Harmful mutations can cause abnormalities in living organisms and are responsible for the various syndromes and disorders found in living organisms. They also cause the disorders to be transmitted from one generation to another. Crouzon syndrome is one such disorder that is transmitted through genes from one generation to another. Patient born with Crouzon syndrome: This is a 15-year-old boy from Patna in Bihar, India who was born with Crouzon syndrome. He has retrusion of his maxillary bone and facial asymmetry. One of his main complaints was a pointed nose. This had been progressively getting worse as he grew up and he had become very socially withdrawn and depressed because of this developing facial deformity. His parents had been very distressed by this and had approached a local surgeon for treatment. Referral to our hospital for surgical management The surgeon examined the patient and explained to the parents that the patient needed to be operated on by an oral and maxillofacial surgeon. He then referred them to our hospital as our hospital is renowned for facial reconstruction surgery in India. Our hospital is one of the few specialty centres for distraction osteogenesis surgery in India. Initial presentation at our hospital for consultation and treatment Dr SM Balaji, facial cosmetic surgeon, examined the patient and formulated a detailed treatment plan for the patient. This included distraction osteogenesis of his maxilla using Kawamoto distractors followed by rhinoplasty surgery at the time of removal of the distractors. He is one of the few surgeons in India who has extensive experience with distraction osteogenesis. The parents of the boy were in total agreement with the proposed treatment plan and signed the informed surgical consent. This surgery will correct the cosmetic congenital defects arising from Crouzon syndrome. It is one of the cosmetic procedures performed on patients with this syndrome. Surgery is performed to help the patient lead a normal life. Plastic surgeons rarely perform this procedure though this can be categorized under facial plastic surgery. Kawamoto distractors are manufactured by KLS Martin, one of the leading manufacturers of cutting edge surgical equipment in the world. Constant research is conducted to advance surgical frontiers to provide better results for patients. Advancements in the field of craniofacial surgical instrumentation is made possible by inputs from leading craniofacial surgeons from around the world like Dr SM Balaji. Our hospital is a leading hospital in India that provides such invaluable feedback to instrument manufacturers around the world. The patient then underwent Le Fort III with distraction osteogenesis using bilateral Kawamoto distractors at our hospital. After about 10 days of consolidation for stabilization of the Kawamoto distractors, distraction of about 1 mm was performed every day bilaterally until a total distraction of 18 mm was achieved bilaterally. Following completion of the distraction, a period of three months was allowed for complete consolidation and stabilization of the distracted maxillary bone. A brief introduction to Crouzon syndrome This is a genetic disorder where there is premature fusion of skull bones. A mutation in chromosome 10 results in Crouzon syndrome. The first branchial arch is affected by this. This results in abnormal development of the bones of the face and the skull. Fusion of the metopic suture results in frontal bossing and trigonocephaly, fusion of the coronal suture results in brachycephaly and fusion of the sagittal suture results in dolichocephaly. Patient presents for removal of distractor The patient now presents three months after successful distraction osteogenesis for removal of the Kawamoto distractors. A rhinoplasty procedure will also be performed at the same time for correction of his nasal deformity. A 3D CT scan was first taken to check for new bone formation. The amount of new bone formation was found to be sufficient. Successful removal of bilateral Kawamoto distractors and rhinoplasty Under general anaesthesia, bilateral incisions were placed through the previous surgical scars, bicoronal flaps were raised, and the temporalis muscle was reflected. The Kawamoto distractors were exposed bilaterally and removed. Closure of the incisions was done using resorbable sutures. Once this had been achieved, the rhinoplasty was then performed. Broad nose correction after distractor removal Through an intranasal approach, intercartilaginous incision was placed and the nasal mucosa was dissected. The medial nasal cartilage was trimmed and medial osteotomies were performed followed by lateral osteotomies bilaterally. Closure was then done using resorbable sutures. Patient and parents express their happiness at surgical result The patient and his parents were very happy with the results of the surgery. His face was symmetrical now and his nose also had a normal contour now without being pointy. They said that he would now be able to lead a normal life as he was very happy with the cosmetic results of the surgery. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

Complete Trismus total inability to open the mouth due to OSMF – Oral Submucous Fibrosis – Nasolabial Flap Surgery

TMJ Ankylosis Surgery – Growth Center Transplantation – CC Graft Surgery

Removal of Calcifications in the masseter muscle surgery

Large Dentigerous Cyst, Multiple times operated Resurgery, Reconstruction with Rib Graft

Hemifacial Microsomia total Absence of Ramus and Condyle Reconstruction with costochondral graft

Fixed Zirconia Bridge for Broken Teeth

Zygoma implants for Atrophic upper jaw

Square Face, Masseter Muscle Excision failed – Resurgery with Gonial Angle Reduction

Lower Jaw Tori Removal Surgery

Crouzon Syndrome Le Fort III Advancement with Kawamoto’s Distraction

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About Us

International Patients

Maxillofacial Surgery

Cosmetic Surgery

Craniofacial Surgery

Syndrome Management

Dental Procedures

sdtotositus togel terbesar di duniasdtotositus togel resmi5 bandar togel terpercayasdtotosdtotoresmi 4dgame tototop totosdtotoStay Up-to-Date with Awesome Content

About Us

International Patients

Maxillofacial Surgery

Cosmetic Surgery

Craniofacial Surgery

Syndrome Management

Dental Procedures

Enquiry / Appointment

sdtoto
situs togel terbesar di dunia
sdtoto
situs togel resmi
5 bandar togel terpercaya
sdtoto
sdtoto
resmi 4d
game toto
top toto
sdtotoStay Up-to-Date with Awesome Content