Graftless dental surgery for Upper Jaw – Zygoma implant surgery – Total Oral Rehabilitation
Patient with complaints of extensive tooth loss and mobility This is a 47-year-old patient from Hubli in Karnataka, India who presented to our hospital with the complaint of difficulty chewing food. He had multiple missing teeth as well as mobility of his remaining teeth. He also had a mobile bridge in right lower posterior region. He stated that he had been having severe pain and sensitivity in the posterior teeth of his mandible for a couple of years now. This had resulted in him avoiding certain food groups, which had led to a gradual weight loss. The patient also had bleeding from his gums upon toothbrushing. He also had chronic bad breath, which had resulted in him avoiding social contact to a certain extent. There was also slight hollowing of cheeks due to soft tissue collapse resulting from absence of many teeth. Seeking a permanent solution for his problems, he had visited a few local dental clinics in his hometown. They had advised him to undergo extraction of all his existing teeth under local anesthesia followed by replacement with a removable denture. It was explained to him that there was insufficient bone in the region of his posterior maxilla and this made it impossible for him to undergo full mouth rehabilitation with dental implants. They explained that bone grafting would solve this problem for the patient, but the patient was not interested in undergoing surgery to harvest bone for grafting from his ribs. One dental surgeon had explained to him that there was the option of placement of zygomatic dental implants to address his problem and had referred him to our hospital for surgical management. He had explained that these surgical procedures needed to be performed at a specialty implant center. Our hospital is a renowned center for zygomatic implant surgery in India. There would be no necessity for bone graft surgery for placement of zygomatic implants. Initial examination upon presentation at our hospital Dr SM Balaji, zygomatic dental implant surgeon, examined the patient. Clinical examination of the patient’s oral cavity revealed generalized gingival recession with bleeding gums. The patient also had chronic periodontitis with resultant mobility of his teeth. The bridge in the lower arch was mobile. There was severe bone loss up to the roots of his left lower posterior teeth region. There was overall severe generalized bone loss. There were multiple missing teeth in the upper arch. Dr Sm Balaji suggested comprehensive imaging studies including orthopantomogram. Treatment planning for full mouth rehabilitation of the patient It was explained to the patient that it would be best to extract all remaining teeth in his mouth. This would include removal of the bridge from his lower jaw. Full jaw mandibular rehabilitation would be through placement of conventional dental implants. Only Nobel biocare implants are used at our hospital. It was advised to the patient that it would be best to use zygomatic implants to rehabilitate the upper jaw as there was insufficient bone for placement of conventional implants in the posterior region of the upper jaw. The patient was in complete agreement with this treatment plan and signed the surgical consent to undergo dental implant surgery. Difference between zygoma implants and conventional implants Zygoma implants are different from conventional dental implants in that they anchor into the zygomatic bone rather than the maxilla. They may be used when maxillary bone quality or quantity is inadequate for the placement of regular dental implants. Successful dental implant surgery for placement of implants Under general anesthesia, the bridge was first removed followed by extraction of the patient’s remaining teeth. A midcrestal incision was then placed following which a flap was elevated. Bilateral sinus lift was done through the lateral window technique followed by placement of zygoma implants bilaterally. The implants remained exposed where there was extensive loss of bone. It was then decided to augment the defects using Creos bone graft and Bio-Oss. Creos is a deproteinized demineralized bone with preserved micro- and macrostructures. It acts as a bone replacement material that is used to increase the body’s own bone. Bio-Oss is composed of the hard, mineral portion of natural bone and has a structure very similar to that of human bone. It is therefore well accepted by human bone tissue and serves as a guide rail for new bone growth. Patient fully satisfied following implant surgery The patient was very happy with the surgery and looked forward to the day full mouth rehabilitation would be completed for him. Healing process took place without untoward incident. He was given a removable partial denture at this time following implant placement. Osseointegration is most likely to occur over a period of the next three to four months. Once adequate osseointegration of the dental implants has been demonstrated through radiographic imaging, the patient would be provided with implant-supported dental prosthesis, which would enable him to once again include all the food groups that had been excluded by him from his diet. This would benefit his long term overall health status. Surgery Video
Cosmetic Rhinoplasty – Tip, Alar base and Root of the Nose Narrowing Surgery
Evolution of nasal forms down the ages The shape of the nose evolved over millions of years as humanity first spread out from its origins in the African continent. This gradual migration of human beings led them to regions with widely varying climates. Human beings colonized all the continents except for the Arctic and Antarctic. These were too hostile for habitation by humans. Those who migrated to cold regions slowly evolved long thin aquiline noses, which helped heat up the air as it entered the respiratory passages and those who migrated to hot climes evolved broad noses with wide open nostrils that helped cool down the air as it entered the respiratory passages. These noses also evolved to esthetically suit the facial forms from each region. Therefore, a Chinese nose would not be the best fit for a European face and vice versa. Surgeons also need to keep this in mind before proceeding with cosmetic nose correction and should counsel the patients before surgery. Patient very conscious of his nasal structure This is a 24-year-old male from Jodhpur in Rajasthan, India who had always felt self conscious of the shape of his nose. He had always felt that his nose had a very broad base along with a bony hump on the dorsum of the nose. This had lead to him desiring to undergo a nasal hump reduction surgery for a long time. The patient felt that his nose was too big for his face and this had subsequently led to the patient avoiding social interactions at work and at home. He had visited a plastic surgeon at his hometown who had advised an open rhinoplasty for the patient. The patient however did not undergo the recommended surgery as it would result in a visible scar on his face. He then visited a cosmetic surgeon who had examined the patient and had referred him to our hospital for surgical management. Our hospital is renowned for rhinoplasty surgery in India. Our hospital is a premier centre for facial cosmetic surgery in India. Plastic surgery in India has increased greatly and is sought after by many patients for cosmetic correction. There was a time in the past when cosmetic surgery was very expensive and only the rich and the famous could afford it; however, with the rising income levels in the country after opening up of the economy to direct foreign investment, the number of people opting for cosmetic surgery has vastly increased. Board certified cosmetic surgeons perform this procedure in western countries. A deviated nasal septum is also corrected through rhinoplasty surgery and can result in subtle nose reshaping. Hump removal can drastically improve the profile of the face. Patient presents to our hospital for initial consultation Dr SM Balaji, rhinoplasty surgeon, examined the patient thoroughly and obtained a detailed history. Our hospital is one of the renowned centres for nose surgery or ‘nose job’ in India. This falls under the purview of facial plastic surgery. The patient explained that he was dissatisfied with the appearance of his nose and wanted correction of the same. He said that he did not want any visible scarring from the surgery. Following this, detailed biometric measurements were then obtained for the patient’s face along with complete radiographic evaluation. It was explained to the patient that a closed rhinoplasty could be performed to correct his nose. Role of the upper lateral cartilages in the appearance of the nose was explained to the patient. The patient expressed understanding of the surgical procedure and signed the informed surgical consent. Surgical correction of his nasal structure General anaesthesia was induced and orotracheal intubation was done. Following this, through an intranasal approach, transcartilaginous incisions were placed on both sides and the nasal mucosa was dissected. The lateral cruces of the lower lateral cartilages were excised bilaterally for aesthetic correction of his nose. The nasal mucosa was then dissected up to the dorsum of the nose. His nasal hump deformity on the dorsum of the nasal bone was then rasped and the nasal bridge was given a straight profile. Following correction of his nasal hump deformity, bilateral Weir excisions were performed at the alar base. The wide alar base was then reduced to narrow the root of the nose. Closure was the incisions were then done using resorbable sutures. The patient was then extubated without incident. Patient fully satisfied with the outcome of his surgery Postsurgical swelling subsided in two weeks and the patient returned for a check up. He expressed complete satisfaction at the results of the surgery and said that the nasal form was perfect and that this would help him regain his self confidence. Surgery Video
Recontour and Restoration of Health for Drug Induced Swollen Gums
[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=”COMPLAINT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 32 year old female patient approached our dental hospital, alarmed on noticing her gums getting inflamed and expanding in size for the past 6 months. Patient gives a history of profuse bleeding of gums while brushing and persistent bad breath. Initially, when the swelling started, the patient had convinced herself that it would heal by itself. Unfortunately, her gums have continued to overgrow to a significant size, over the period of time. The patient feared to speak confidently. She was not able to eat food properly, as her gums were painful at times. She worried that her bad breath could ruin the relationship with her fellow mates. Her swollen gums looked unpleasant and moreover, had compromised her oral functions. Hence patient demanded for a solution to her long-standing problem.[/vc_column_text][vu_heading style=”2″ heading=”MEDICAL HISTORY” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient was known to be hypertensive (a person with high blood pressure) and on antihypertensive drug (TAB NORVASC 5MG) once a day for the past 5years. A thorough blood investigation revealed no systemic abnormalities.[/vc_column_text][vu_heading style=”2″ heading=”EXAMINATION” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, there was generalized inflammation of her gums. However, the gum tissue surrounding her lower front teeth were enormously enlarged in size. There was profuse bleeding from the inflamed gums on slight touch. The patient had mild to moderate pain at the relative site on palpation. Moreover, the teeth were covered with severe tartar and stains, owing to the poor oral hygiene followed by the patient. This buildup of bacteria in her mouth induced inflammation and gave off unpleasant odor. In correlation with the medical history of the patient, this sudden abnormal enlargement of the gums were seemed to be induced by the intake of the antihypertensive drug. Tab Norvasc , which is a composition of `AMLODIPINE’ is said to be widely associated with gingival overgrowth. In general , antihypertensive drugs, anticonvulsant drugs and immunosuppressant’s are commonly associated with gingival enlargement. Not many patients are aware of its side effects on oral health. These drugs increases the accumulation of connective tissue in the gums, leading to DIGO (Drug induced gingival overgrowth). On radiological examination, full mouth x-ray taken shows generalised bone loss of the teeth in the upper and lower jaw. There was generalized spacing in between the teeth in the upper and lower anteriors. Severe build-up of plaque with tartar due to poor oral hygiene has resorbed the underlying jaw bone over the period of time, which led to periodontally weakened teeth. [/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On view of the patient’s condition, Our highly skilled periodontist (gum specialist), under the guidance of Dr. SM Balaji planned to perform full mouth curettage followed by correction of lower jaw gingival overgrowth by gingivectomy under local anesthesia.[/vc_column_text][vu_heading style=”1″ heading=”Gingival curettage / root surface debridement” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Gingival curettage is a method, performed to clean the parts of teeth, which are below the gum-line and cannot be reached with a toothbrush. It is done to remove plaque and tartar from the tooth roots. Eventually, gums heal and tighten around the tooth again.[/vc_column_text][vu_heading style=”1″ heading=”Gingivectomy” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Gingivectomy is a surgical procedure done to remove and reform the excessively overgrown gum tissues. The treatment procedure and the maintenance to be followed were clearly explained to the patient. Patients consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”PRECAUTIONS TAKEN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Before initiating the procedure, patient was referred to physician for his consent and consideration for substitution of drug (amlodipine) with other antihypertensive drug. Meanwhile the patient was asked to maintain a strict oral hygiene. Patient reported after 2week, on discontinuing the drug for the dental procedure.[/vc_column_text][vu_heading style=”2″ heading=”PROCEDURE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Prior to gingival curettage, Phase I of superficial scaling was performed on the patient to remove stains and tartar above the gum line. Once local anesthesia was administered to the patient, Phase II of gingival curettage was carried out. The procedure was performed with a hand- activated instrument called `periodontal curette’. This is a typical instrument used to remove the hard tartar on the root surface of the tooth. The curette is placed inside the gum, adapted to the root surface, and pulled out, removing the bacteria filled deposit. This results in a smooth root surface, free of plaque and calculus. Followed by this Phase III of Gingivectomy is carried out. The diseased gingival tissue is surgically cut and removed, re-contouring the lower jaw gums to a more natural state. The gum tissues are approximated with absorbable suture. The procedure is completed with a chlorhexidine mouth rinse.[/vc_column_text][vu_heading style=”2″ heading=”MAINTENANCE PHASE ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient was put on antibiotics and painkiller for 5 days. A chlorhexidine mouthwash was prescribed to be used for a duration of 2weeks. Post- surgical sensitivity of the teeth was managed with a desensitizing toothpaste. Consistent proper oral hygiene maintenance was recommended to achieve the desired result and to prevent further gum infection. Patient was asked to report after 2 weeks.[/vc_column_text][vu_heading style=”2″ heading=”THE HAPPY PATIENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient reported after 2 weeks. Clinically, there was no sign of inflammation. Healing was uneventful. The gingival tissues were well adhered to the teeth. Patient happily reported that there was no sign of gum bleeding while brushing. Also, she felt confident to speak, as her bad breath vanished! Instructions on home care routine was given, as re- occurrence of gum infection and periodontal pockets, solely depends on the patients oral care habit and maintenance. Patient is on a regular follow-up.[/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=”5766″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5767″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5768″ img_size=”full” add_caption=”yes”][/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=”5769″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5770″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5771″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row]
TMJ Ankylosis ( Lockjaw) tracheal stenosis with tracheostomy and Gap Arthroplasty Surgery
TMJ injuries in childhood Falls are common in childhood. However, a child’s bones are more flexible than adult bones and thus the chances of fractures are lesser than adults. Adult bones are denser and more mineralized that the bones of children. However, there are certain injuries that are more common in children, which lead to complications. Injuries to the chin where there is direct impact from a fall can lead to injuries to the TMJ. When the impact is sufficiently high, this can lead to bleeding into the TMJ. In many instances, the child might not complain too much of pain in the TMJ. The parents might not be aware of the seriousness of the injury because of this and do not seek medical attention. Consequences of injury manifesting with passage of time It is only the passage of time that reveals the serious consequences that arise from this injury. The bleeding into the joint space results in bony fusion of the joints with the glenoid fossa leading to arrest in the growth of the lower jaw and difficulties with eating and speech. Most cases of bony ankylosis of the mandible that arises in childhood could have been averted with timely medical help. It is therefore very important to seek medical help if such an injury occurs even if the child does not exhibit pain or too much discomfort in the period immediately after the fall. The consequences of neglecting such an injury are high with the child needing to undergo multiple surgeries along with the psychosocial stress that arises from having facial deformity because of this. Initial diagnosis of bilateral TMJ ankylosis and sleep apnea This is a 7-year-old boy from Meghalaya in India who had first presented to Balaji Dental and Craniofacial Hospital in Chennai at the age of 5 with the chief complaint of a retruded mandible and displacement of the tongue to the back of the mouth. This boy had fallen down on his chin as an infant. This had been neglected by his parents at that time. Over time, his jaw growth stopped and he was unable to open his mouth to any degree. They had taken him to a facial plastic surgeon in his hometown. A plastic surgeon in India normally performs a wide variety of surgeries. He however informed them that he performed only cosmetic surgery and referred them here as our hospital is renowned for jaw correction surgery in India. Our hospital rigorously follows the protocols laid down by the American Association of Oral and Maxillofacial Surgeons. Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained a detailed history from the parents. His parents said that the boy periodically stopped breathing during sleep and resumed his breathing with a loud gasp. The patient was diagnosed with bilateral TMJ ankylosis and sleep apnea resulting from backward placement of the tongue due to the micrognathia. Need for multistage surgical correction explained to the patient Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and restarts. It was explained to them that surgery needed to be done in two steps for complete correction of the patient’s problems. Orthognathic surgery or sleep apnea correction surgery was performed first as it had to be corrected first. Release of the bilateral TMJ ankylosis would be performed at a later date. A tracheostomy had to be performed due to his restricted mouth opening following which bilateral mandibular body distraction osteogenesis surgery corrected his micrognathia. Bone grafts would not be needed taking into account the age of the patient. Parents present with patient for TMJ ankylosis surgery The patient presented with his parents now for corrective jaw surgery for release of his bilaterally ankylosed TMJ. He still has difficulty eating as he was still unable to open his mouth. His parents stated that he has been on a predominantly liquid diet and has lost quite a bit of weight because of this. Presurgical diagnostics and treatment plan for the patient Dr SM Balaji examined the patient and ordered comprehensive imaging studies. The patient’s 3D CT revealed that there was complete bony ankylosis between the mandibular condyle and glenoid fossa. His mouth opening was zero due to bilateral TMJ ankylosis. It was decided to perform a tracheostomy as intubation would not be possible due to nil mouth opening. TMJ ankylosis surgery would be performed following the tracheostomy. Surgical release of the bilateral TMJ ankylosis Under general anesthesia, a horizontal skin incision was first made through the previous tracheostomy scar. Minimal dissection was carried out and the strap muscles were retracted. A tracheal incision was made and maturation sutures placed. A tracheostomy tube was then inserted following which skin closure was done in layers. Attention was then turned to the bilaterally ankylosed temporomandibular joints. An incision was first made in the submandibular region bilaterally and dissection was performed down to the temporomandibular joint. The ankylosed bone was osteotomized bilaterally and gap arthroplasty was performed. Following excision of the bony mass, mouth opening was achieved passively to about 35-40 mm. The incisions were then closed using sutures. Postsurgical care for the patient Mouth opening of about 3.5 mm was achieved at the time of surgery. Physiotherapy was initiated for the patient after surgery with jaw exercises under supervision. Mouth opening exercises were also performed for about a month with regular follow up. The parents were very happy and satisfied with the results. They expressed their delight that he was able to eat normal food without any restrictions now and has slowly begun to gain weight since then. They were instructed to return after six months for a final checkup at the hospital Surgery Video
Jaw symphyseal bone grafting surgery for dental implant
Patient with a history of unilateral cleft lip and palate repair The patient is a 22-year-old from Dehradun in Himachal Pradesh, India who was born with a left sided unilateral cleft lip and palate. Lower facial growth is at times affected on the side of the cleft. Speech development is also affected if there is velopharyngeal incompetence. This is characterized by the presence of a hole in the roof of the mouth that creates a direct communication between the oral and nasal cavity. Speech therapy is needed after completion of the surgical phase of rehabilitation for complete normalization of speech. Surgical repair of his cleft lip defect had been performed when he was 4 months old. This was performed at a local hospital. He had later undergone cleft palate repair when he was 10 months old. Cleft lip repair is ideally performed at 4 months of age and cleft palate repair is ideally performed at 10 months of age. He had later undergone alveolar cleft reconstruction at the age of 3-1/2 years. His teeth however erupted in a malaligned fashion due to his cleft defects. He had undergone fixed orthodontic correction of his malaligned teeth at the age of 12 years. His left lateral incisor was however congenitally missing due to the location of the cleft in the region of the left lateral incisor. It had been advised to his parents that placement of a dental implant at that site would complete the rehabilitation process for him. He had undergone bone grafting with iliac crest to facilitate placement of the implant but there had been failure of the graft. A second bone graft surgery was attempted, but that too resulted in failure of the graft. He had been very disappointed by this and had settled for a removable denture to replace his missing left lateral incisor. Referral to our hospital for bone graft surgery and dental implant placement The patient had sought consultation at a few dental hospital regarding bone graft surgery, but they had expressed their inability to perform that surgery. It was then that an oral surgeon in Nainital had informed the patient that this procedure could be performed successfully at a specialty cleft lip and palate repair hospital and had referred the patient to our hospital for treatment Initial examination and treatment planning at our hospital Upon arrival at our hospital, Dr SM Balaji, cleft lip surgery and cleft palate surgery specialist, examined the patient and obtained a detailed oral history. A 3D CT scan was obtained to study the region of the bony cleft in detail. This revealed deficient alveolar bone in the region of the left lateral incisor. The patient also had malocclusion of his teeth despite undergoing fixed orthodontic treatment elsewhere. It was explained to the patient and his parents that he first needed to undergo fixed orthodontic treatment first so that sufficient space could be created for placement of the implant. This would be followed by bone graft placement at the site of the bony deficiency to enable placement of the dental implant. This bone graft would be harvested from the mandibular symphyseal region as the previous grafts from the iliac crest and rib region had been rejected. The patient and his parents were in agreement with this treatment plan and the patient began fixed orthodontic treatment. Sufficient space was created after six months of treatment for placement of the implant and the patient is now ready for bone graft placement. Successful placement of bone graft in the maxillary bone Under general anesthesia, a crevicular incision was made in the anterior mandible and a flap was elevated to expose the symphyseal bone. Bone cuts were made in the region and a strip of buccal cortical bone was harvested from the region. Following this, a midcrestal incision was placed in the maxilla in the region of the left upper lateral incisor and a flap was elevated. The area of the bone defect was then exposed and reconstructed using the bone graft, which was fixed in place using titanium screws. Closure of the incision was done using resorbable sutures. Implant surgery planning The graft was perfectly placed in the region of the bony defect in the maxilla. A period of three to four months would be allowed for the graft to successfully blend in with the maxillary bone following which dental implant surgery would be performed. A further period of six months would be allowed for complete osseointegration of the implant with the bone following which a crown will be placed on the implant to complete rehabilitation of the patient. A crown is an artificial tooth that is fabricated to mimic a natural tooth and is fixed on top of the implant. These artificial teeth are fabricated from ceramics or zirconium. Implant surgery can also be performed under local anesthesia in cases without any complications. The patient and his parents were extremely happy with the results of the surgery and were instructed to report back to the hospital in three to four months for dental implant surgery. Surgery Video
Sri Venkateswara Dental College Anti-Ragging programme
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][/vc_section][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=”Invited as chief guest at Sri Venkateswara Dental College” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji, Hon’ble Member, Dental Council of India was invited to be the chief guest at the Antiragging Orientation Programme at Sri Venkateswara Dental College, which was organized by the college authorities to raise awareness amongst the students about the Antiragging Act of 2010. He was warmly welcomed by Prof Lodd Mahendra, Principal, Sri Venkateswara Dental College and Dr Jothimurugan, Vice chancellor, Vels University.[/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=”5742″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5743″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5744″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][vu_heading style=”2″ heading=”An introduction into the consequences of ragging” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji spoke at length about the consequences ragging had on the life of students and how it could result in irreparable harm in the lives of all concerned. Ragging, he said, is something that students think is harmless, but can have devastating consequences when it goes wrong.[/vc_column_text][vu_heading style=”2″ heading=”An Anecdote from student days recalled ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]He spoke about the infamous ragging incident that happened in a dental college in Tamil Nadu in 1997 that had culminated in the death of a fresher and arrest of the involved seniors. He spoke about how it would not only affect the students, but also the parents and the families of those involved and how the grief arising from such untoward incidences would have to be borne by those involved to their graves.[/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=”5746″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5747″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][vu_heading style=”2″ heading=”Invaluable guiding advice for the future” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The aim of his speech was to educate the students about what lay ahead in their lives and the success and happiness that would result from pursuing dentistry as a career choice. He told them that all this could be jeopardized by undesirable behaviors that accompanied instances of ragging. He explained that they needed to develop the focus and drive to sustain them in a lifetime pursuit of gaining skills to succeed in life. He said that the foundation of this focus and drive needed to be laid during their college life and they should not waste time on anything that could distract them from it.[/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=”5748″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5749″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][vu_heading style=”2″ heading=”An incomparable career in Oral and Maxillofacial Surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]He also spoke to them about his passion for maxillofacial and craniofacial surgery and how he had developed this focus while he was in college as an undergraduate student. He said that the sky was the limit as far as achievements in their career were concerned provided they had the right focus. He then presented his Textbook of Oral and Maxillofacial Surgery to a meritorious student of the college at the conclusion of the function[/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=”5750″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5751″ img_size=”full” add_caption=”yes”][/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_single_image image=”5752″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5753″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row]
Bilateral Macrostomia Correction Surgery
What is macrostomia? Macrostomia refers to an unusually wide mouth. Macrostomia is characterized as a physical abnormality that causes clefts to form on the face of affected individuals. These clefts can form on one or both sides of the face. They have an increased rate of occurrence in males. The incidence of macrostomia is about 1 in every 150,000-300,000 live births. Macrostomia usually occurs as one of the symptoms of a more complex disease process such as craniofacial microsomia. Effects of macrostomia in the life of an affected individual This is a condition that affects facial esthetics. It could affect the patient’s psychosocial development if left untreated. Surgical correction is the only solution available for correction of this condition. Selection of the correct surgeon should be done carefully by the patient’s parents. Establishment of facial symmetry should be of paramount importance in this surgery. A face that is asymmetric or with heavy scarring invariably leads to the patient isolating themselves from others. Clefts result from improper development and fusion of the mandibular and maxillary processes. Clefts cause problems with facial muscle development. This would result in impairment of speech function in the patients. Surgical correction of macrostomia deformity would not only result in a dramatic aesthetic improvement in the patient’s face, but would also ensure that the patient’s speech develops normally. Development of normal speech in a patient with macrostomia Although speech language pathology can be considered in certain cases, speech therapy intervention is rarely required as the surgery is performed and macrostomia corrected even before the infant begins to talk. The patient is referred to a speech language pathologist if required by the surgeon during the course of long term follow up of the patient’s condition. This surgery falls under the purview of oral and maxillofacial surgeons as well as board certified plastic surgeons in Western countries. This is a cosmetic procedure as well as a functional surgery. Both cosmetic and functional correction is important as each plays a significant part in the rehabilitation of the patient. Baby girl born with unusually wide mouth This is a 3-month-old baby girl from Jalandhar in Punjab, India. She was born with an unusually wide mouth. This was diagnosed with macrostomia at birth. Her parents were advised to take her to a plastic surgeon. A plastic surgeon who examined her at her hometown felt that surgical correction of her facial deformity would be best addressed by an oral and maxillofacial surgeon who was also a cosmetic surgeon. He therefore referred her to our hospital as our hospital is renowned for macrostomia surgery in India. Our hospital is also a premier center for facial cosmetic surgery in India. All varieties of facial cosmetic surgery procedures are performed routinely in our hospital. Macrostomia correction falls under the category of plastic and reconstructive surgery. Initial presentation at our hospital for consultation and treatment planning Dr SM Balaji, a premier facial cosmetic surgeon in India, examined the patient thoroughly and made the diagnosis of bilateral lateral facial clefts and macrostomia deformity. It was explained to the patient’s parents that surgical correction of macrostomia deformity is ideally performed at the age of 3 months. He decided to correct the patient’s bilateral macrostomia deformity through the vermillion return flap technique. Surgical correction of bilateral macrostomia in the infant Under satisfactory general anesthesia, both corners of the mouth were first marked to ensure that surgical correction of the macrostomia would result in symmetry of the mouth. Care was taken to maintain the integrity and continuity of the muscles of the mouth. The orbicularis oris was reconstructed along with ensuring the natural blending of the mucosa with the skin at the oral commissures. Closure was done in layers to ensure that there was establishment of overall balance between the mouth contour and cheek skin. This was achieved through suturing the tissues in three layers using the mucosa, muscles and finally the skin. Successful outcome of the macrostomia deformity correction surgery Her parents were extremely happy with the results of the surgery. Complete symmetry of the mouth had been achieved as a result of the surgery. Even the minimal scarring would slowly fade away as the baby grew. They expressed their total satisfaction at the results of the surgery before final discharge from the hospital. Surgery Video
Pharyngoplasty Surgery -Speech Correction Surgery with Positive Suction test
Parents of girl with cleft repair surgery seek solution for speech problems The patient is an 11-year-old girl from Cuttack in Orissa, India who was born with a unilateral cleft lip and palate. This is the most common among birth defects in the world. Lower facial growth can be impeded by this deformity. The patient had undergone cleft lip surgery/cleft lip repair at three months of age and cleft palate surgery/cleft palate repair in the upper jaw at 9 months of age. Her cleft alveolus reconstruction had been done at 3-1/2 years of age. All the surgeries had been performed in her hometown. Plastic surgeons also commonly perform this surgery in many countries. Cleft lip and cleft palate deformities These are the most common birth defects in the world. Native Americans babies have the highest incidence of cleft deformities in the world while blacks and Hispanics have amongst the lowest rates of occurrence in the world. The percentage of occurrence is somewhere in the middle in India, but the real time numbers are extremely high because of the high birth rate in the country. Cleft lip and palate deformity can arise from genetic or environmental factors. Infants with clefts are born more often to parents with cleft deformities themselves. A great deal of research is being done around the world to isolate the genes responsible for cleft deformities. Many environmental factors such as maternal use of tobacco, alcohol, drugs or even electromagnetic waves have been credited with the formation of cleft deformities in infants. Parents dissatisfied with results of the surgery Her parents were however not satisfied with the results of the surgeries. Her speech had always been compromised and they felt like air was escaping through the roof of her mouth into her nose while speaking. This made it difficult for her to pronounce certain sounds and her parents said it felt like she was speaking from a bottom of a well. She was also having recurrent middle ear infections. This had led to problems in school with teachers complaining to them that they could not understand her speech. She began to become socially withdrawn and started avoiding going outside. Her parents were very worried as she had no friends and was feeling very lonely. Patient referred to our hospital for surgical correction Parents decided to get this problem addressed and visited a big city hospital for consultation. The oral and maxillofacial surgeon at that hospital examined the patient and explained to the parents that her problem needed to be addressed at a specialist cleft lip and palate surgery hospital and referred her to our hospital. He informed them that cleft lip surgery in India is a highly specialized field and cleft palate surgery in India is mainly performed in specialty centers Initial examination at our hospital Dr SM Balaji, cleft lip surgeon and cleft palate surgeon, examined the patient and performed a complete clinical and radiological evaluation of the patient. He explained to the parents that the hole in her palate was preventing her from vocalizing certain sounds correctly. He explained that urgical correction would completely correct her velopharyngeal insufficiency. What is the cause behind velopharyngeal insufficiency? Velopharyngeal insufficiency refers to the condition where the soft palate does not come in contact with the back of the throat during speech. This causes air to escape into the nose through the back of the throat during speech. When this happens, it causes the speech to develop a prominent nasal twang. A sphincter pharyngoplasty is performed to correct this condition. Treatment planning for successful resolution of nasal speech It was explained to the patient’s parents that a sphincter pharyngoplasty would need to be performed for correction of this condition. The parents were in full agreement after the surgical procedure was explained to them in detail. It was then decided to proceed with surgery. Successful performance of surgery Under general anesthesia, flaps of tissue were taken from just behind the tonsil on each side. These flaps were next connected together across the back of the throat and sutured together. This narrowed down the opening of the throat with just a small, central opening or port in the middle for breathing through the nose. A positive suction test, which was performed at the completion of the surgery, demonstrated good lifting of the soft palate thus indicating successful surgery. Parents express total satisfaction with results of the surgery Improvement in the patient’s speech was immediate and drastic. The patient’s parents were extremely happy that the patient would not be able to speak normally. They had always felt that normalizing the speech problems would enable their daughter to lead a normal life. They were counseled that she would need the help of a speech therapist for further management of her speech problems. Surgery Video
Facial Asymmetry Correction Surgery – Bilateral Sagittal Split Surgery
Modalities of facial asymmetry correction Facial asymmetry correction surgery needs an eye for esthetics on the part of the surgeon. It can be achieved solely through surgery or in conjunction with orthodontic treatment when malocclusion of the teeth is also a component of the facial asymmetry. No human face is perfectly asymmetric. Everyone has a slightly asymmetric face. The facial contours are slightly different on the right and left sides of the face. This however is for the large part imperceptible. When the patient has crooked teeth, particularly the front teeth, orthodontic appliances are used to correct this before proceeding with surgery. The patient needs to have healthy teeth before proceeding with orthodontic treatment. Carious teeth have to be restored and gum health has to be optimal before beginning orthodontic therapy. It is only at the completion of preliminary orthodontic therapy that surgery is performed. Orthodontic appliances can either be fixed or removable. Removable appliances are used when minor tooth movements like tipping of anterior teeth is the only orthodontic correction required. Fixed orthodontic treatment is required for more complex corrections. Lingual braces are used for patients who are particular about their braces not being visible to others. Martial artist with gradual development of facial asymmetry The patient is a 35-year-old male martial artist from Srinagar in Kashmir, India who has been competing in tournaments for over 20 years now. He had started developing problems with his jaws when he was around 20 years old. His lower jaw developed an extreme crossbite due to jaw deviation and he started to experience difficulty with speech and eating. It reached the point where normal function became impossible. He then approached a local oral and maxillofacial surgeon for management of his problem. Upon examining the patient, the surgeon realized that the degree of deformity was extreme and that very few surgeons in India performed these surgeries. He then referred the patient to Balaji Dental and Craniofacial Hospital in Chennai for surgical management of his problems. Our hospital is renowned for facial asymmetry surgery and corrective jaw surgery in India. He fixed up an appointment with the hospital manager and flew down to Chennai. Incidence of facial asymmetry in the general population Facial symmetry is a fallacy as it does not exist. Even Hollywood stars have the smallest degree of facial asymmetry though it cannot be easily perceived. Among the general population, facial asymmetry can at times be noted at the clinical or subclinical level. It is only when it is obvious or interferes with function that people seek treatment. Facial asymmetry can either be congenital or acquired. Treatment plan for facial asymmetry is formulated depending upon factors such as age, severity and cause. Patient undergoes initial evaluation at our hospital Dr SM Balaji, facial asymmetry correction surgeon, examined the patient and obtained a detailed oral history. The patient related that he holds a black belt in Karate and has won many tournaments over the years. He said that he has been kicked innumerable times in the jaws over the course of his career as a martial artist though he related that he does not recall any particular injury that could have triggered the development of his facial asymmetry. The patient stated that he started noticing the jaw deviation around 15 years ago, but had ignored it at that time. This has slowly gotten worse over time and he decided to seek medical help once it began to make normal functioning impossible. Clinical and radiological evaluation revealed that the patient had a crossbite with class III malocclusion and high arched narrow palate. Treatment planning for correction of the facial asymmetry It was recommended to the patient that he undergo lower jaw surgery for correction of his facial asymmetry as well as orthodontic treatment for management of his malocclusion. Patient undergoes surgical correction of his asymmetry Under general anesthesia, eyelets were first placed in both the jaws and interarch wiring was performed thus orienting the mandible into desired occlusion. Incisions were then made in the mandibular retromolar regions bilaterally and a flap was elevated. Following this, bone cuts were performed and bilateral sagittal split osteotomy done. Adequate care was taken to protect the inferior alveolar in from the proximal segment of the mandible to protect it from injury during surgery. The mandible was then pushed backward following which occlusion was checked and the jaw fixed using titanium plates and screws. The incisions were then closed using resorbable sutures. Full correction of facial asymmetry The patient expressed his complete satisfaction at the outcome of the surgery. His occlusion had become completely normal and his asymmetry had been corrected. He expressed his relief at this correction and was given instructions to return for orthodontic treatment to correct his malaligned teeth. Surgery Video
Sphincter pharyngoplasty for hypernasality (Velopharyngeal incompetency) Surgery for Nasal Speech
Cleft lip and palate deformities in antiquity Cleft lip and palate were viewed differently by different cultures. Some cultures were more accepting while others outright rejected infants born with these deformities. Chinese doctors in antiquity had developed ingenious ways to conceal cleft defects and many infants born with cleft defects grew up to become fully integrated in adult society. However, in ancient Greece, these children were considered to be from the devil himself and were abandoned in the forest to die. As scientific knowledge grew gradually with the advent of scientific thought, these deformities came to be better understood and society became more accepting of people born with these deformities. Patient with surgically corrected unilateral cleft lip and palate This patient, who is 16 years of age, is from Solapur, India. He was born with unilateral cleft lip and palate. This had resulted in a deformed upper lip and upper jaw. Surgical repair was planned for his condition. He had undergone cleft lip surgery elsewhere when he was 4 months old and cleft palate repair when he was 12 months old. An alveolar cleft reconstruction surgery was then subsequently performed when he was 7-1/2 years old. All the surgeries were performed in his home state of Maharashtra. Cleft palate usually requires orthodontic treatment of permanent teeth. These surgeries are also performed by board certified plastic surgeons in Western countries, but are performed by oral and maxillofacial surgeons in countries like Japan, China, India, etc. This is one of the most common congenital birth defects seen around the world. Surgical procedures to correct these defects have been developed over the years to give very good esthetic results for the patient. There is a higher incidence of cleft lip and palate in children born to parents with cleft lip and palate. Ear infections and hearing problems can also be more common in children with cleft deformities. Speech difficulties faced by the patient all his life He had always had difficulty conversing clearly with air escaping through his nose while speaking. He had approached an oral surgeon at his hometown for a solution to his problem. The oral surgeon had examined him thoroughly and had explained that he needed a sphincter pharyngoplasty for correction of his problem. He had further explained that this was a procedure that needed to be performed at a specialty cleft lip and palate center and had referred him to our hospital for management of his problem. Our hospital is renowned for cleft lip and palate surgery along with pharyngoplasty surgery in India Initial presentation at our hospital for treatment Dr SM Balaji, pharyngoplasty surgery specialist, examined the patient in detail. He conducted a speech assessment test and confirmed that the patient had velopharyngeal insufficiency. The patient’s speech had a nasal twang and there was escape of air to his glottis. Following this, a complete clinical and radiological evaluation was done. It was explained to the patient that correctional surgery yielded best results before 3-1/2 years of age, but since it had been performed only at 7-1/2, the results of the surgery would not be optimal as performed at 3-/1 years. Velopharyngeal insufficiency (VPI): Velo refers to the velum or soft palate. It is the part of the roof of the mouth that moves with vocalization of the “ah” sound. Pharyngeal refers to the throat (pharynx). During vocalization of certain sounds, the palate rises to touch the back of the throat and sends the air out of the mouth. In a person with velopharyngeal insufficiency, the soft palate does not contact the throat during speech, which results in escape of air through the nose. This causes a great deal of inconvenience to the patient as their speech is not easily discerned by others. Treatment planning for correction of the patient’s complaint It was decided to perform a sphincter pharyngoplasty to correct the patient’s problem of air escaping into the nasal cavity during speech. This surgery is performed under general anesthesia. Flaps of tissue from behind bilateral tonsils are connected across the back of the throat. This narrows down the throat opening, leaving just a small central opening or port in the middle for breathing through the nose. A positive suction test was performed at the conclusion of the surgery to test for proper seal. There was elevation of the soft palate thus confirming successful outcome to the surgery. Successful outcome for the surgery Improvement in the patient’s speech was dramatic and immediate after surgery. The patient was very happy with the outcome of the surgery and expressed his complete satisfaction at the results. As for his speech problems, the patient will later be referred for speech therapy for further improvement in his speech. Surgery Video