Blog - Balaji Dental and Craniofacial Hospital

May 31st, 2019 09:51 pm May 31, 2019

Large Periapical Dental Cyst Removal and Reconstruction of Upper Jaw with Rib Graft

What is a cyst and what are the problems arising from cysts? A cyst is a sac with a membranous lining that separates the contents of the sac from the surrounding tissues. This lining is comprised of cells that are abnormal when compared to the surrounding cells. The contents of the cystic sac can comprise of many materials. These include air, fluids, solids or even semisolids. A cyst does rarely resolve on its own at times through it has to be surgically removed when it persists. A cyst that occurs within a bone can lead to resorption of the bone due to pressure and can weaken the bone. This can lead to serious complications when it is present in long bones like the femur, tibia or fibula. Examples of cysts include epidermoid cyst, ganglion cyst, chalazion cyst, hydatid cyst, glial cyst, dentigerous cyst and dermoid cyst. All these cysts need to be addressed surgically to excise them. Complete excision of the cyst lining is mandatory as any remnants left behind could lead to recurrence of the cyst. Bone grafting is necessary to fill in the defect when removal of the cyst results in a large bony defect. Patient presents with a complaint of a swelling in the anterior maxilla The patient is a 22-year-old male from Varanasi, India who presented with the complaint of a swelling in the anterior maxilla with a mobile tooth in the upper front teeth region. He stated that the tooth was hit by a ball while playing cricket in his childhood. This was followed by a pain and a mild swelling in that region, which subsided spontaneously a few days later. The patient’s parents did not seek any medical help for the patient. He said that he first noticed a swelling in that region around a year ago with gradual loosening of his right upper central incisor. This swelling had gradually grown in size along with increasing mobility of the tooth. He had approached a local dental surgeon in his hometown who had obtained radiographic studies. The radiographic studies revealed a large area of radiolucency in the region, which was diagnosed as a cyst. As the cyst was very large, there was loss of a considerable amount of bone in that region. The dentist explained to the patient that this needed surgical intervention and referred him to our hospital for cyst removal surgery. Our hospital is a specialty center for jaw reconstruction surgery in India. Alveolar bone graft surgery is a specialty feature of our hospital. Initial presentation at our hospital for treatment of his swelling Dr SM Balaji, jaw reconstruction surgeon, examined the patient and obtained a detailed oral history. He also ordered comprehensive radiographic studies for the patient including a 3D CT scan of the region. Clinical examination revealed that the patient had a swelling involving the upper maxilla and palate. His right upper central incisor was very mobile and was displaced buccally. The patient’s radiological studies revealed that there was a cystic lesion extending from the right lateral incisor to the left lateral incisor with extensive destruction of surrounding alveolar bone. A biopsy obtained from the area confirmed it to be a periapical cyst. Treatment plan formulated and explained to the patient It was explained to the patient and his parents that the cyst needed to be enucleated in its entirety along with extraction of the mobile right central incisor. There would be no necessity to extract any remaining teeth in the affected region as it was a periapical cyst. It was also explained that a rib graft needed to be harvested for bone grafting as there was extensive bone loss in the region of the cyst. Surgical procedure for correction cyst removal and jaw reconstruction Under general anesthesia, a right inframammary incision was made and a costochondral rib graft was harvested. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Following this, a crevicular incision was then made in the maxilla over the region of cystic involvement. A mucoperiosteal flap was then elevated and the cystic defect exposed. This was followed by enucleation of the cyst taking care to ensure that the entire lining of the cyst was removed. The mobile right central incisor was also extracted. Electrocauterization was then done followed by flushing the area with an antibiotic solution. The area of bony defect was then packed with rib grafts following which the wound was closed with resorbable sutures. Successful outcome of the surgery Surgery was successful with establishment of normal alveolar bone contour following placement of the rib grafts. Healing was uneventful and the patient was very happy with the outcome of the surgery. Surgery Video frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="">

May 29th, 2019 02:41 pm May 29, 2019

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Reconstruction of Condyle (Jaw Joint) Coronoid and Ramus using rib graft for Hemifacial Microsomia

An introduction to hemifacial microsomia Hemifacial microsomia is a congenital disorder that affects the development of the lower half of the face. It most commonly affects the ears, the mouth and the mandible. It usually occurs only on one side of the face, but rarely may involve both sides of the face. If severe, it may result in breathing difficulties due to obstruction of the trachea—sometimes even requiring a tracheotomy. With an incidence in the range of 1:3500 to 1:4500, 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, Goldenhar syndrome and Franceschetti syndrome. Surgical procedures for correction of the resulting facial asymmetry is the only remedy available for patients with hemifacial microsomia. Fat grafting into areas of soft tissue deficiency is one mode of treatment. The aim of reconstructive surgery is to restore symmetry to facial structures. It involves performing both oral and maxillofacial surgery as well as plastic surgery procedures. Temporomandibular joint surgery is performed in case of involvement of the joint. Tooth extractions might be needed if there is a tooth at the site of the bony cut placed for mandibular distraction. Patient with gradually developing facial asymmetry The patient is a 23-year-old female from Varkala in Kerala, India whose parents began to notice developing facial asymmetry since her infancy. It gradually kept worsening over a period of time until it became cosmetically unappealing. A doctor in her hometown diagnosed her with hemifacial microsomia and recommended that they wait until adulthood before they sought surgical correction of her facial asymmetry. She had become socially withdrawn and quiet over the years and hardly left the house. She also kept her head tilted onto the right shoulder in an attempt to conceal the asymmetry. This had resulted in chronic neck pain for the patient. They recently met with an oral and maxillofacial surgeon near their hometown who referred them to our hospital for hemifacial microsomia surgery. Our hospital is a renowned specialist center for facial asymmetry surgery in India. Initial presentation at our hospital for consultation Dr SM Balaji, facial asymmetry correction surgeon, examined the patient and ordered comprehensive imaging studies. Complete clinical and radiological examination done. Clinical examination revealed facial asymmetry on the right side along with torticollis on the right side. Torticollis or wry neck is a form of dystonia that is defined by an abnormal, asymmetrical head or neck position, the etiology of which might be due to a variety of causes. The term torticollis is derived from the Latin words tortus, which means twisted and collum, which means neck. The patient’s 3D CT scan revealed a hypoplastic right ramus. She also had an ear tag on the right side of her face. Treatment planning formulated for the patient Dr SM Balaji planned to do ramus distraction osteogenesis for correction of her facial asymmetry, but since there was insufficient bone at that site for the distraction osteogenesis, it was decided to do the surgery in two steps. The first step would involve obtaining a costochondral rib graft and recreate a coronoid and reinforce the mandibular ramus. This surgery would result in creation of sufficient bone for distraction. Once the grafts have been adequately consolidated in the area, the patient would then undergo the distraction osteogenesis. Successful recreation of the coronoid and mandibular ramus Under general anesthesia, a right inframammary incision was first made and costochondral rib grafts were harvested. A Valsalva maneuver was then performed to ensure absence of perforation into the thorax following which closure of the incision was then done in layers. A right submandibular incision was then made and dissection was performed up to the condyle. The bone grafts were crafted to the right size and the coronoid was recreated along with augmentation of the ramus of the mandible. These grafts were then fixed with titanium screws and the incisions closed with resorbable sutures. A postoperative OPG taken two months after the surgery showed evidence of sufficient bone consolidation at the site of the grafting. The patient’s face was also more symmetric. The patient would return in six months for her distraction osteogenesis. The patient’s parents expressed their thankfulness as the patient’s hemifacial microsomia had affected the patient to such a degree that the whole family had been affected by it. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

May 27th, 2019 08:46 pm May 27, 2019

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Simultaneous Alveolar Bone Graft and Cleft Rhinoplasty Surgery

[et_pb_section admin_label=”section”] [et_pb_row admin_label=”row”] [et_pb_column type=”4_4″][et_pb_text admin_label=”Text”] Classification of cleft lip and palate surgery Surgery for the correction of a cleft lip and palate comes under both functional as well as cosmetic surgery. Other cosmetic procedures include face lifts, tummy tucks, removal of signs of aging such as wrinkling of skin, other forms of skin care surgery such as removal of warts and scars, brow lift and eyelid surgery. Wrinkling of skin is a sign of ageing. This is a physiological process and happens with due course of time. Premature wrinkling can lead to loss of confidence in a person. This can be corrected by tightening the skin by pulling it near the jaw line. An experienced surgeon is needed to perform this to perfection as it may lead to a mask like appearance of the face if done incorrectly. Facial lifts are performed this way. All these come under facial plastic surgery. Bilateral cleft lip and palate surgery is the most severe form of cleft. Correction of cleft lip and palate deformity is performed by an oral and maxillofacial surgeon. Board certified plastic surgeons also perform these above mentioned surgeries in the developed nations of the world. Patient with a history of unilateral cleft lip and palate The patient is a 25-year-old male from Ranchi in Jharkhand, India who was born with a unilateral cleft lip and palate deformity. He had undergone cleft lip surgery at the age of 3 months and cleft palate surgery at the age of 9 months. Pharyngoplasty had been performed at the age of 3-1/2 years to improve his speech and correct his velopharyngeal insufficiency. Alveolar cleft defect reconstruction was done at the age of 4 years. All the surgeries were done elsewhere. The patient has always had a nasal deformity due to his cleft, which has always made him feel very self conscious. He had always been a loner because of this and has few friends. His worried parents had consulted a doctor in their hometown who advised them to get this corrected surgically. He had then referred the patient to us as our hospital is renowned for cleft rhinoplasty surgery. Our hospital is a premier center for all varieties of facial cosmetic surgery in India. Initial presentation and examination at our hospital Dr SM Balaji, facial cosmetic surgeon, examined the patient and ordered comprehensive imaging studies. Imaging studies revealed a noticeable depression in the right anterior maxillary region. Since the patient is a case of unilateral cleft on the right side, the right side of the nose was depressed along with a depressed nasal bridge. The right nostril was also depressed. It was explained to the patient that the depression in the right maxilla needed to be corrected with placement of a rib graft along with a costochondral graft for nose correction. The right anterior maxillary graft would add bulk to the lip contour thus elevating the base of the nose. A lip revision and Weir excision was also planned for the patient. Successful surgical correction of the nasal deformity Under general anesthesia, an incision was first placed in the right inframammary region and a costochondral rib graft was harvested. This was followed by a Valsalva maneuver, which demonstrated a patent thoracic cavity without any perforations. The incision was then closed in layers. Following this, a sulcular incision placed in the right anterior maxilla and a flap was elevated. A rib graft was crafted to fit into the defect in the right anterior maxilla. This was then fixed in place using titanium screws. Next, a transcartilaginous incision was made in the left nostril and dissection was done up to the dorsum of the nose. Following this, the nasal bridge was then augmented using a costochondral rib graft. A strut graft was also placed to elevate the right nostril. This was then followed by lip revision surgery with Weir excision done on the left side. Full patient satisfaction at the results of the surgery The patient was very satisfied with the results of the surgery. He expressed his happiness at the cosmetic outcome of the surgery. His parents expressed their thankfulness to the surgical team, saying that this would enable the patient to lead a normal life. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">[/et_pb_text][/et_pb_column] [/et_pb_row] [/et_pb_section]

May 26th, 2019 01:52 pm May 26, 2019

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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 width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

May 25th, 2019 07:53 pm May 25, 2019

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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 width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

May 24th, 2019 01:28 pm May 24, 2019

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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]

May 19th, 2019 05:33 pm May 19, 2019

smbalajiSurgery 331

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 width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

May 11th, 2019 12:57 pm May 11, 2019

smbalajiSurgery 331

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 width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

May 8th, 2019 09:27 pm May 8, 2019

smbalajiEvents 87

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]

May 7th, 2019 09:27 pm May 7, 2019

smbalajiSurgery 331

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 width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

Large Periapical Dental Cyst Removal and Reconstruction of Upper Jaw with Rib Graft

Reconstruction of Condyle (Jaw Joint) Coronoid and Ramus using rib graft for Hemifacial Microsomia

Simultaneous Alveolar Bone Graft and Cleft Rhinoplasty Surgery

Graftless dental surgery for Upper Jaw – Zygoma implant surgery – Total Oral Rehabilitation

Cosmetic Rhinoplasty – Tip, Alar base and Root of the Nose Narrowing Surgery

Recontour and Restoration of Health for Drug Induced Swollen Gums

TMJ Ankylosis ( Lockjaw) tracheal stenosis with tracheostomy and Gap Arthroplasty Surgery

Jaw symphyseal bone grafting surgery for dental implant

Sri Venkateswara Dental College Anti-Ragging programme

Bilateral Macrostomia Correction Surgery

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About Us

International Patients

Maxillofacial Surgery

Cosmetic Surgery

Craniofacial Surgery

Syndrome Management

Dental Procedures

Enquiry / Appointment

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