Reduction Genioplasty (Chin Correction) Surgery
Patient unhappy with the masculine appearance of her prominent chin The patient is a 27-year-old girl from Amritsar in Punjab, India who has always felt that her chin was too prominent. She felt that this gave her a very masculine look with an excessively long lower face. Her friend had suggested to her that she could get it surgically corrected. She then presented to an oral surgeon seeking correction of her problem. A thorough examination was performed and it was explained to her that she required surgery at a specialist surgical center. He referred her to our hospital for chin reduction surgery. Our hospital is renowned for facial cosmetic surgery in India. The patient has been undergoing orthodontic treatment in our hospital for correction of malaligned teeth for the past 2 years. Our hospital follows all the protocols for surgical procedures as laid out by the American Association of Oral and Maxillofacial Surgeons. We are also a renowned center for corrective jaw surgery in India. Various cosmetic surgical procedures such as eyelid surgery, brow lift, face lifts, chin augmentation, chin reduction, rhinoplasty correction, microtia ear reconstruction, forehead reduction and eyelid correction are performed at our hospital. Our hospital is a world renowned specialty center for cleft lip and palate correction surgeries. Chin surgeries, like all cosmetic surgeries, require not just good surgical skills, but also an eye for esthetics in order to balance the chin with the rest of the face. The result of the surgery should blend in with the rest of the face and should add to the overall esthetic appeal of the face. It has been repeatedly demonstrated through scientific studies that when the patient feels that there is a definite improvement in the esthetics of the face, it always leads to increased self confidence and motivation, thus resulting in an overall improvement in the quality of life. Evolutionary basis for development of secondary sexual characteristics A prominent or large chin is associated with a masculine appearance. Before the advent of agriculture and modern civilizations, mankind was essentially a hunter gatherer society. It was the males who went out to hunt and the women stayed back and took care of the children. These hunts were often violent and males developed thick sturdy bones in comparison to women in order to withstand the impact and stress that resulted from the hunts. This got coded within the genes and big prominent bones became predominantly associated with males and a delicate bony structure became predominantly associated with females. It is because of this that the development of prominent bones in females led to a sense of discontent in them regarding the esthetics associated with it. A prominent chin in females is visually incongruent with a normally sized upper jaw. Reduction in the size of the chin always results in dramatic improvement in facial features. This results in long term health benefits because the patient does not feel self conscious anymore and gains more self confidence as a result of this surgery. Initial presentation and examination at our hospital Dr SM Balaji, jaw reconstruction surgeon, examined the patient thoroughly. He then ordered comprehensive imaging studies for the patient including a 3D CT scan, which revealed a very prominent mental protuberance. This caused the patient to have a protruding chin with resultant increase in lower facial height. It was explained to the patient that her lower facial height needed to be reduced to give her a more feminine appearance. This would be accomplished by pushing the chin backwards, which would result in reduction of height as well as the prominence. Surgical correction of the patient’s prominent chin Under general anesthesia, a sulcular incision was first placed in the mandibular anterior region. A flap was then elevated and the chin region was exposed. Cuts were made in the bone of the chin region below the apices of the lower anterior teeth and a strip of bone was removed. The chin was then pushed backwards and fixed in place using titanium plates and screws. The incision was then closed using resorbable sutures. Patient expresses satisfaction at the outcome of the surgery The patient was very happy with the results of the surgery. She said that her face had become very feminine with the reduction in the prominence of the chin bone. She expressed her total satisfaction at the results of the surgery before final discharge from the hospital. Surgery Video
Large mandibular defect (Lower jaw) after sleep apnea surgery – Bone grafting
What is a cyst? A cyst is a cavity, which has a thin wall and usually contains fluid that is present in the body. Cysts are always pathological in nature and have to be removed. When cysts are allowed to persist, they can grow to enormous sizes and cause local destruction of surrounding structures. They can also become infected and cause considerable pain. The only treatment is through surgical removal through enucleation of the entire cyst. Care has to be taken to ensure that the cyst is removed in its entirety. Even leaving behind the smallest remnant of the cyst can result in recurrence of the cyst. A few examples of cysts are ovarian cyst, sebaceous cyst, pilonidal cyst, primordial cyst and dentigerous cyst. Cysts are more common in the lower jaw than in the upper jaw. There have been rare instances where the jaw joint has been affected by cysts. This could lead to TMJ disorders thus requiring TMJ reconstruction surgery. Patient with a history of sleep apnea surgery The patient is a 35-year-old male from Kolkata in West Bengal, India who had a history of sleep apnea. This had been diagnosed after a series of sleep studies performed in his hometown. He had undergone mandibular box osteotomy for correction of sleep apnea around 10 years ago. This is a form of corrective jaw surgery. He stated that his sleep apnea had reduced significantly. A postoperative sleep study had indicated that he had an improvement of about 50% of oxygen saturation during sleep. Development of pain and swelling in the left lower jaw for the past one month Over the past one month, the patient had begun to notice a sharp pain in the region of his lower back teeth. There was also an associated swelling in that region. A friend suggested that this might be due to wisdom teeth problem and suggested that he visit a dentist. He had visited a dental clinic in his hometown where diagnostic studies had been obtained. There was an area of radiolucency in association with his left premolar. Suspecting that this could be cystic in nature, the dental surgeon referred the patient to our hospital as our hospital is a reputed oral and maxillofacial surgery hospital in India. We are also renowned for cyst removal surgery in India as well as jaw reconstruction surgery in India. Surgery costs are nominal in India when compared to the developed nations of the west. Patient presents to our hospital for initial assessment of his swelling Dr SM Balaji who is one of the premier oral and maxillofacial surgeons in India examined the patient and obtained a detailed oral history. He also went through the patient’s old surgical records. Following this, the patient underwent a complete clinical and radiological examination with a 3D CT scan. There was a small swelling in relation to the lower left premolar teeth. The 3DCT scan revealed that the patient had a cyst in left lower front teeth region. This cyst extended from the lower left canine to the lower left second premolar. There was also radiolucency noted at the site of the box osteotomy that had been previously performed for the patient’s sleep apnea. Treatment planning for removal of the cyst and jaw reconstruction It was explained to the patient that he needed to have his cyst enucleated followed by reconstruction of the bony defect with bone graft. The graft was planned to be harvested from the iliac crest. The patient was in complete agreement with the proposed treatment plan and signed the informed surgical consent. There would be no necessity for any facial plastic surgery for the patient. Successful surgical enucleation of the cyst Under general anesthesia, a crevicular incision was first made over the region of the cyst following which a flap was elevated. The area of the cystic defect in the mandible was then identified and enucleated in its entirety. Assessment of the residual bony defect was done before harvesting the bone graft from the iliac crest. A linear incision was then made over the iliac crest following which adequate bone graft material was harvested using the trapdoor technique. Closure of the incision was then done in layers The area of the residual bony defect from the cyst enucleation was then packed with bone graft. Bone graft was also placed over the box osteotomy site to promote bone formation. Closure was then done using resorbable sutures. All the teeth in the region were retained and no teeth were extracted during the surgery thus negating the need for any dental implants for the patient. Patient completely satisfied with treatment outcome The patient was extremely happy with the results of the surgery. The swelling in the mandible was gone as was the pain in the region. He expressed his complete satisfaction before final discharge from the hospital. Surgery Video
Lower Jaw Advancement Surgery BSSO for Micrognathia and Double Chin Correction
Surgical correction of jaw deformities through oral and maxillofacial surgery Jaw deformities are a common occurrence. They can be congenital, iatrogenic, traumatic or pathologic. Jaw deformities can affect the life of a person in two ways. One is the cosmetic aspect of the deformity and the other is the functional aspect of the deformity. Facial deformities can lead to a loss of confidence in the person as it can make them very self conscious about their deformity. This can lead to them withdrawing from social contact and isolating themselves. The other aspect is the functional difficulties that arise directly from the deformity. This can be in the form of eating difficulties and speech difficulties. Inability to eat well will cause the patient to avoid certain food groups because of difficulty with chewing. This can be so serious that it could result in malnutrition or undernutrition due to inadequate dietary intake. Whatever the etiology of the deformity may be, surgical correction is the only remedy. In some cases, excess bone has to be reduced. In some cases, bone length has to be increased. Increasing bone length is done through distraction osteogenesis or through bone grafting. The technique used is determined by the nature of the deformity. All these can be described as corrective jaw surgery. Patient with a history of multiple cosmetic surgeries performed elsewhere The patient is a 35-year-old male from Kagazhnagar in Telangana, India who has an extensive past surgical history. He stated that he has had nasal septum deviation correction surgeries in Delhi many years ago. This surgery was performed twice in two years at the same hospital. The results of these surgeries however did not satisfy him. He also felt that he had an extremely retruded lower jaw, which was making his chin appear very bulky because of a double chin. This was causing him to become very self conscious about his appearance and he was losing his self confidence. He had approached multiple hospitals to get this corrected, but had been turned away because of the complexity of the surgical procedure. He had visited a dentist in his hometown recently who had referred him to our hospital for correction of his problem. It had been explained to him that only specialty oral and maxillofacial surgery hospitals were equipped to perform jaw reconstruction surgery in India. Our hospital is renowned for jaw advancement surgery in India. We are also renowned for facial cosmetic surgery in India. Plastic surgeons do not perform this surgery as this is more of a specialized surgery for an oral surgeon than a facial surgery. The jaw joints will be left untouched as there are no TMJ disorders associated with this. Initial presentation at our hospital for surgical management Dr SM Balaji who is one of the foremost jaw reconstruction surgeons in India examined the patient and obtained a detailed oral history. He then ordered comprehensive imaging studies for the patient. Clinical examination revealed that the patient had a double chin. There was also minimal malocclusion present along with a normal class I molar relationship. A formal treatment plan was formulated and described in detail to the patient. The initial phase would involve orthodontic correction of the patient’s minimal malocclusion. This would then be followed by a bilateral sagittal split osteotomy to bring the patient’s retruded mandible forward. This would enable the patient to get a prominent chin as well as would completely eliminate the patient’s double chin. The patient was in complete agreement with the above treatment plan and signed the surgical consent for the procedure. Surgical correction of the patient’s cosmetic problems Under general anesthesia, incisions were made bilaterally in the retromolar area of the mandible following which flaps were elevated to expose the mandibular bone. Bone cuts were made in the region and a bilateral sagittal split osteotomy performed. Extreme care was taken to separate the inferior alveolar nerve from the proximal segment of the mandible and protect it during the entirety of the surgery. No wisdom teeth extractions were performed during this surgery. The mandible was brought forward and the occlusion was then checked using a splint that had been prefabricated by the orthodontist. Titanium plates and screws were then used to fix the mandible and stabilize it. The incision was then closed using sutures. Successful correction of the patient’s complaints The patient had the desired edge to edge relationship of the anterior teeth following the surgery. His double chin was also corrected completely thus avoiding the need for a second surgical procedure. The patient was extremely happy with the results of the surgery. He said that he would now be able to function normally without being self conscious about any of his facial features. The surgery, he said, had not only transformed his face, but would also help transform his life. Surgery Video
Dental Implants for Grossly Decayed Teeth
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”CASE REPORT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This is a case of a 32 year old male patient. He approached our Dental Hospital hoping to find a solution for his long standing dental defect. The patient complained that his upper front teeth were broken, discolored and unpleasant aesthetically. He expressed that his neglect towards oral hygiene over the period of years, affected his teeth and compromised his oral functions to a great extent. Also, the patient grumbled upon his difficulty to chew food, as his upper posterior teeth were also in a bad state of condition. He expressed his desperate need to fix his teeth, as it affected his self confidence and well being. [/vc_column_text][vu_heading style=”2″ heading=”EXAMINATION” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, the patient’s upper anterior and posterior teeth were grossly decayed, that only the root portion of the teeth structure remained, which cannot be conserved. The lower jaw teeth were in the initial stages of decay, due to the poor oral care of the patient. A full mouth x-ray (OPG) taken shows, badly cavitated and damaged teeth in the upper jaw.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]After complete examination of the patient, considering the patients need and age, Dr. SM Balaji, Maxillofacial surgeon and Implantologist, decided to extract the badly decayed teeth and root stumps, followed by Dental Implant placement under local anesthesia. Patient was completely satisfied with the treatment plan. Consent was obtained[/vc_column_text][vu_heading style=”2″ heading=”DENTAL IMPLANT PLACEMENT ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr.S.M.Balaji extracted the defective teeth in the upper jaw that cannot be preserved by means of any dental treatment, under local anesthesia. Subsequently, the gum tissue surrounding the relative site were raised exposing the underlying jaw bone. Dental implants of appropriate height were fixed in the bone. A total number of five teeth were removed in the upper anterior region, yet, a set of three implants has been fixed at the relative site, which will later be covered by the loading of a fixed ceramic bridge onto the implants. This was done to make the treatment cost effective for the patient. Closure of the elevated gum tissue is achieved with absorbable suture. Patient was asked to report after a duration of 3 months. This healing period is required for the dental implants to completely integrate with the jaw bone. Until then, a provisional prosthesis was given to the patient, to replace his missing teeth.[/vc_column_text][vu_heading style=”2″ heading=”THE MAKEOVER” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient came back after 3 months. Post operative OPG taken shows well positioned dental implants, fully consolidated with the jaw bone. Final measurements were taken and bite trials seen. Later, ceramic bridge of exact color match to his natural teeth were fixed to the implants. The patient was very happy to have a natural-looking smile and to be able to bite and speak well.[/vc_column_text][/vc_column][/vc_row][/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=”” width=”1/2″][vc_single_image image=”5708″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5709″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5710″ img_size=”full” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5711″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row]
Unilateral Cleft Nose Rhinoplasty Surgery
Etiology behind cleft lip and palate deformities Cleft lip and palate deformities are the result of the breakdown of normal mechanisms that are behind the formation of the face in utero. The incidence of this deformity varies between races, geographical locations and socioeconomic backgrounds. These can manifest as just a simple notching in the lips to complete clefting of the lip, alveolus and palate. Treatment approaches also vary according to the severity of the deformity. There is a very strong genetic basis to the formation of cleft lip and palate. Environmental factors can also play a role in the appearance of this deformity. A great deal of time and money is being invested around the world to identify the genes responsible for cleft formation; however, this is easier said than done as this involves a complex interplay of various genes. Environmental factors too play a big role in the formation of clefts. These include exposure to industrial solvents, abuse of drugs such as methamphetamines and cocaine during pregnancy, exposure to tobacco smoke and also ingestion of certain pharmaceutical drugs during pregnancy. Patient born with a unilateral cleft lip and palate This 25-year-old patient from Asansol in West Bengal, India was born with a unilateral cleft lip and palate. He always felt that his nose looked ugly and was very conscious because of that. He stated that he always preferred to be alone because of his nasal deformity. The patient said that he always wanted a normal looking nose with a prominent tip. He also complained of a residual scar in the upper lip from his previous surgery where there was no hair growth. Previous history of surgical correction The patient had previously undergone cleft lip surgery at around 3 months of age followed later by cleft palate repair along with palatoplasty as an infant elsewhere. Cleft alveolus reconstruction surgery had been done at the same hospital at the age of 4 years. He had also undergone rhinoplasty with nasal reconstruction through bone grafting elsewhere about one year ago. The roof of the mouth had been adequately repaired followed these surgical repairs. This surgical procedure is commonly performed by plastic surgeons in specialty children’s hospitals in the Western countries. Many patients with cleft palate deformity develop speech problems and need long term speech therapy for normal speech development. Referral to our hospital for nasal deformity correction The patient desired to undergo nasal defect correction surgery as well as scar removal surgery as he felt they would dramatically improve the quality of his life and make him more self confident. He approached a local oral surgeon who felt that the patient needed to undergo surgery at a specialty center for rhinoplasty surgery. The patient was thus referred to our hospital as we are a renowned for cleft rhinoplasty surgery in India. Initial examination and treatment planning Dr SM Balaji, specialist in cleft lip surgery and cleft palate surgery examined the patient thoroughly and went over his previous medical records. The patient’s unilateral cleft on the left side had left his nose depressed. There was also a considerable size discrepancy between the size of the nostrils with a smaller left nostril. A noticeable depression in the left anterior maxillary region also added to the nasal deformity. The scar near the philtrum was devoid of any hair growth. It was explained to the patient that he needed a lip revision surgery followed by augmentation of the left anterior maxillary region and nose correction with costochondral rib grafts. Augmentation of the left anterior maxilla would elevate the base of the nose leading to considerable cosmetic improvement. Surgical correction of nasal deformity Under general anesthesia, an incision was first made in the right inframammary region and costochondral rib grafts were then harvested. A Valsalva maneuver confirmed that there was no perforation into the thoracic cavity following which the incision was then closed in layers. Attention was next turned to the lip scar revision surgery. The scar tissue along the philtrum was excised completely and the skin edges were approximated using fine sutures. This was followed by a sulcular incision in the left anterior maxillary region. A flap was then elevated and the left anterior maxilla was augmented using rib grafts, which were fixed using titanium screws. Next, a transcartilaginous incision was placed in the right nostril, dissection was performed, and a strut graft was placed to elevate the left nostril. Patient expresses satisfaction at surgical outcome The patient was extremely happy with the results of the surgery. He now had a more symmetrical and prominent nose. There was also complete removal of the scar on the lip. He expressed complete satisfaction before final discharge from the hospital. Surgery Video
Forehead Reduction with Zygoma and Nose Narrowing Surgery
The effects of facial asymmetry Our face gives us our primary identity. We are defined by our facial features. Even though no human face is perfectly symmetrical, it is imperceptible to the naked eye. Noticeable facial asymmetry leads to psychological effects and patients tend to avoid social contact and isolate themselves. Many cases of facial asymmetry are caused by trauma while some are the result of disease conditions such as tumours, congenital developmental deformities like cleft lip and cleft palate or hemifacial microsomia. Treatment modalities have slowly evolved over the ages to address these issues and present surgical techniques can provide very good results for patients. Research into development of biocompatible materials that can be used to restore facial asymmetry provides best results for the patients. These materials are hypoallergic and are not easily rejected by the human body. The various branches of surgery that deal with correction of facial asymmetry include plastic surgery, oral and maxillofacial surgery, craniofacial surgery and cosmetic surgery. It takes years of experience to master the various surgical techniques associated with correction of facial asymmetry. Deformity of the forehead after a road traffic accident This is a 22-year-old male from Rohtak in Haryana, India who slowly began to notice a growing asymmetry to his face about a year ago. The right side of his forehead and cheekbone was growing larger with the passage of time. This reached a point where it began to worry him and his parents. Alarmed at this abnormal growth in bone, they approached a local neurosurgeon. The neurosurgeon examined him and obtained pertinent studies. They were advised that there were no neurological signs of concern seen in the patient. The patient was then referred to our hospital for surgical management of his condition as we are renowned for craniofacial surgery in India. Our hospital is also a premier centre for facial deformity surgery as well as for facial cosmetic surgery in India. These fall under the ambit of plastic surgery. Face lifts also fall under these categories of surgery. All varieties of cosmetic procedures involving the face, head and neck are performed in our hospital. Our hospital rigorously follows surgical protocols laid down by the American Society of Plastic Surgeons, which is the gold standard even in all developed countries. Experienced craniofacial surgeons also make for some of the best plastic surgeons. Initial examination and treatment planning Dr SM Balaji, facial cosmetic surgeon, examined the patient and obtained a detail oral history. He ordered a 3D CT scan of the skull to assess the full extent of the deformity. It was noted that the patient had an enlarged frontal sinus along with the frontal bone enlargement as well as a very prominent zygomatic bone. There was also a deviated nasal bridge because of this abnormal growth in bone. Findings were discussed in detail with the patient along with the proposed treatment plan. Reduction of the frontal bossing was planned through a bicoronal approach. Right zygoma reduction was planned through an intraoral approach in order to avoid any visible scarring followed by a reduction rhinoplasty. The patient was in complete agreement and signed the informed surgical consent. All pre-operative investigations were done and surgery was scheduled. Surgical correction of the patient’s facial deformities Under general anaesthesia, a bicoronal incision was first made from tragus to tragus. The scalp was then reflected up to the orbit. The area of abnormal growth in the frontal bone was identified and excessive frontal bone was trimmed. During the procedure, the frontal sinus lining was carefully separated from the anterior table without any tears. A titanium mesh was next fixed to the defective area for stabilization. Closure was done using surgical staples with placement of a surgical drain. Following correction of the forehead defect, the prominent right zygomatic bone was addressed. Through an intraoral approach utilizing a sulcular incision, a flap was raised following which the zygomatic bone was identified and reduced. The incision was then closed with sutures. This was followed by lateral osteotomies to both sides of the nasal bridge for reduction of the nasal width. The patient was extubated following successful completion of the nose job surgery. Successful outcome of the surgery The patient was extremely happy with the outcome of the surgery. He said that his facial deformity had been eliminated completely and his facial symmetry had been re-established. The patient expressed complete satisfaction at the final aesthetics that had been achieved through surgery. Surgery Video
Asymmetry of face Correction by Internal Lower jaw Distraction Surgery (Simultaneous Maxilla and Mandible
Occurrence of facial asymmetry True symmetry cannot exist in nature. There is always a degree of asymmetry in everything. It can be so mild that it cannot be noticed or it can be severe enough to be easily noticeable. Every human face is slightly asymmetric. In most cases, it is barely perceptible and is not disfiguring. However, when it is cosmetically disfiguring or causes functional problems, it needs to be corrected through surgical procedures. A wide range of surgery procedures and cosmetic procedures have been developed over time to correct this disfigurement. One of the signs of aging is the increase in facial asymmetry. This can be the result of loss of tone in the soft tissues. The degree of facial asymmetry caused by old age is negligible and needs no treatment. Board certified plastic surgeons are the specialists who deal with these problems in the United States. Oral and maxillofacial surgeons also offer this treatment in India. There are components of functional as well as cosmetic correction in these surgeries. Trauma to the temporomandibular joint is one of the most common causes of lower face asymmetry in the world. Direct impact to the chin can result in trauma to the jaw joint, which can ultimately result in ankylosis of the joint. Release of ankylosis of the jaw is usually accomplished through interpositioning of the temporalis muscle in the joint. Mobilization of the TMJ is done early. Muscle relaxants are given if there is spasm of the jaw muscles and physical therapy exercises that aid in increasing mouth opening are performed to aid in quick recovery of the patient. Development of TMJ ankylosis from a childhood trauma The patient is a 23-year-old girl from Erode, India who fell down and sustained a direct injury to her chin as an infant. Her mouth opening gradually began to decrease until it finally became very limited. This led to difficulty with feeding and speech. There was also deviation of the lower jaw to the left side as she grew older. Around eight years ago, it reached a point where it made functioning difficult for her and her parents visited a dentist for consultation. He diagnosed her to have ankylosis of the left temporomandibular joint and referred her to our hospital for TMJ ankylosis surgery. Our hospital is renowned for TMJ surgery in India. The first surgery at our hospital Dr SM Balaji examined the patient and obtained imaging studies, which confirmed the diagnosis of left TMJ ankylosis. He then explained to her parents that she needed surgical correction of her ankylosed left TMJ. He proposed performing a gap arthroplasty with temporalis muscle interpositioning to release her ankylosed joint. Her mouth opening improved greatly after surgery, but her facial asymmetry persisted. Her facial asymmetry began to gradually worsen as she grew older. She also developed a retruded mandible. This began to affect her day to day life and she lost self confidence. She isolated herself inside her house and refused to socialize. This worried her parents a great deal and they brought her again to our hospital for comprehensive treatment. Referral to our hospital for surgical management of her facial asymmetry Upon examining her, Dr SM Balaji, facial cosmetic surgery specialist, examined the patient and ordered a 3D CT scan of the patient’s mandible. This revealed that the mandible had shifted to the left side because of the TMJ ankylosis. Clinical examination revealed an obvious facial asymmetry with the presence of an occlusal cant. The right side of the mandible was also longer than the left side. Even though the defect was observed on the right side clinically, the patient would need to undergo treatment on the left side to correct the facial asymmetry through the use of mandibular distractors. A mandibular ramus distractor would be fitted on the left side to increase the length of the mandible. A Le Fort I would also be performed on the maxilla for correction of the patient’s occlusal cant. This was explained to the patient and her parents in detail who agreed to the procedure and signed the surgical consent. Mandibular ramus distractor fixation surgery performed on the patient Under general anesthesia, an Incision was first made in the left mandibular retromolar region with elevation of a flap. Bone cuts were then made in the mandible and the mandibular ramus distractor was fixed on the left side using titanium screws. A sulcular incision was then made in the maxilla following which a Le Fort I osteotomy was performed for mobilization of the maxilla. The left posterior maxilla was then fixed using transosseous wires. Mandibular distraction performed for correction of facial asymmetry Intermaxillary fixation was then performed. Following a latency period of about a week, a distraction of 1 mm was performed everyday for a total of 19.5 mm. Distraction was terminated after achieving satisfactory lengthening of the left side of the mandible. A titanium plate was then used to stabilize the maxilla after correction of the patient’s occlusal cant. The distractor will be removed after consolidation of bone at the site of distraction. Patient expresses satisfaction The patient and her parents were extremely happy and expressed their complete satisfaction before discharge from the hospital. They will present again after three to four months for removal of the distraction device from the mandible. Surgery Video
Dental Implant and Ceramic Prosthesis for Fixed Replacement of Missing Teeth
[vc_section content_layout=”full” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_row content_layout=”boxed” equal_height=”” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column layout=”normal” vertical_align=”top” animation_delay=””][vu_heading style=”2″ heading=”PATIENT FROM VELLORE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 56 year old male patient from Vellore, Tamil Nadu, India, approached our Dental Hospital seeking for a permanent replacement of his missing teeth. The patient had allegedly, got his upper and lower posterior teeth removed, due to extensive decay, at his native a few years back. The patient had been experiencing great difficulty to bite and chew food properly. Patient had been using a removable denture for the past 1year to hide his dental defect. He lacked self confidence and was hesitant to smile.[/vc_column_text][vu_heading style=”2″ heading=”COMPLAINT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient complained that, the denture often got displaced on talking and chewing. On the other hand, there has been recurrent ulcers in his mouth due to long hours of wearing the denture. Also, he was not able to taste and relish his meals as the upper denture covered the roof of his mouth. This had altered the patient’s standard of living and appearance. Patient demanded for a fixed option that would last for a lifetime and, significantly, improve his well-being.[/vc_column_text][vu_heading style=”2″ heading=”ANALYSIS OF THE PATIENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Clinically, there were missing posterior teeth in the upper and lower jaw, with missing anterior teeth in relation to the lowers. Preoperative OPG taken revealed lack of posterior teeth in the upper and lower jaw. On the other hand, there was sufficient bone height with regard to the relative site, which makes him an ideal candidate for a fixed treatment option.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]In view of the patient’s need and demand, maxillofacial surgeon and Implantologist, Dr. SM Balaji planned to replace the missing teeth with Dental Implants under local anesthesia, followed by a fixed prosthesis downstream. Patient’s medical history affirmed no abnormalities. Consent obtained from patient to move on with the treatment plan.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PROCEDURE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under local anesthesia, the gum tissue surrounding the corresponding site is cut and elevated, exposing the underlying jaw bone. Dental Implants of appropriate size are placed in the bone with stability and retention. Once the implants are in place, the surgical site is thoroughly flushed with saline. The gum tissues were then approximated with dissolvable suture. A course of antibiotics and painkillers were prescribed to the patient.[/vc_column_text][vu_heading style=”2″ heading=”FOLLOW-UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A temporary prosthesis had been given for the patient’s use for the time being. A duration of 3 months was required for the dental implants to completely osseointegrate with the teeth bearing bone. Until then, the patient continued on with the provisional prosthesis. Post operative x-ray taken showed well positioned, integrated, Dental implants. Post-satisfactory healing, final impression was taken and bite registration was done. A natural looking ceramic prosthesis was fixed onto the dental implants. The prosthesis instantly gave him a makeover. The patient was so happy that, he couldn’t stop smiling![/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=”5685″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5686″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5687″ 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=”5688″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5689″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5690″ 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=”5691″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5692″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Comminuted Zygomatic Bone Fracture ORIF Surgery
Increased incidence of road traffic accidents in India Following the liberalization of the Indian economy in the mid 80s followed by the entry of many foreign manufacturers into the country, the number of vehicles on the roads has exponentially increased in every part of the country. The number of two wheelers on the road is extremely high; however, road infrastructure has not kept up with this explosion in the numbers of vehicles. This compounded with lax enforcement of traffic rules has led to an increase in the number of road traffic accidents as never before. Most of these accidents are low velocity medium impact because of the density of vehicles on the roads. Many two wheeler riders do not wear a helmet though helmet use has been made mandatory by law. Patient involved in a road traffic accident This is a 23-year-old male from Katpadi, India who was riding his bike to college when he was involved in a minor road traffic accident. The bike skidded when the patient avoided a pothole and he fell onto his face impacting his left cheek bone. This led to facial injury in the form of mild abrasions on the skin as well as a sharp pain in the region. The patient was not wearing a helmet. He was taken to a nearby hospital where emergency treatment was provided. The skin abrasions were thoroughly debrided with removal of any blood clots contaminated with road debris and a tetanus toxoid injection. An x-ray was obtained of the left zygoma region as the patient complained of extreme pain in the region. This revealed the presence of a fracture of the left zygomatic bone. The emergency doctor at that hospital immediately referred the patient to Balaji Dental and Craniofacial Hospital, Chennai for surgical management of his fracture as we are renowned for facial trauma surgery in India. A cast or splint would be ideal to treat fractures of long bones; however, they are not applicable in the case of fractures of the face arising from maxillofacial trauma. Soft tissue injuries are common with facial trauma as the skin in the facial region is very soft and delicate. Initial presentation at our hospital with treatment planning Dr SM Balaji, facial trauma surgeon, examined the patient and obtained a detailed history. The patient stated that he felt an obvious depression on the left side of the face. Comprehensive imaging studies were obtained and revealed a depressed comminuted left zygoma fracture. An open reduction of the fracture needed to be performed as a closed reduction would not be able to deal with the extent of the fracture. It was advised that bone fragments at the site of the fracture needed to be elevated back to their original anatomical position and fixed with plates. The whole procedure would be performed through an intraoral approach in order to avoid any visible facial scars. Patient and his parents were in agreement with the plan and signed the informed surgical consent. Our hospital strictly adheres to the surgical protocols laid down by the American Association of Oral and Maxillofacial Surgeons. Le Fort fractures and other facial fractures that arise from motor vehicle accidents can at times be life threatening and our hospital is fully equipped to deal with any emergency arising from such situations. Surgical correction of the depressed comminuted zygoma fracture Under general anesthesia, an incision was first made in the left maxillary sulcus. A flap was then raised and the comminuted zygoma fracture was exposed. The fracture fragments were then identified. They were then brought back into correct anatomical alignment and fixed using titanium plates and screws. The zygoma was then elevated, stabilized and fixed with titanium plates and screws. There was complete alignment of the fracture fragments with reestablishment of facial symmetry. There were no complications from the surgery. Patient and parents express satisfaction with results of surgery The patient and his parents were extremely satisfied with the results of the fracture reduction surgery. The depression in the patient’s face had been corrected and there was reestablishment of facial symmetry. It was advised that he take a liquid diet for one to two weeks followed by a semisolid diet. The patient and his parents expressed understanding of the instructions. Helmet safety explained to the patient and his parents It was explained to the patient and his parents that the fracture could have been avoided if the patient had been wearing a full face helmet as the patient’s face would have been completely protected at the time of the accident. An open face helmet would provide protection only to the skull and not to the face. Only a full face helmet would provide complete protection for the face also. Emphasis was placed on the point that the helmet strap would need to be secured for the helmet to offer effective protection at the time of an accident. Surgery Video
Large Dentigerous cyst excision and reconstruction with rib graft
Patient with a left lower facial swelling for one year This is a 28-year-old patient from Haryana, India who developed a swelling on the lower left side of the face. The teeth in this region gradually became mobile as the swelling increased in size. This alarmed her a great deal and she presented to a dentist. He obtained x-rays and diagnosed the swelling to be a dentigerous cyst as there were numerous impacted supernumerary teeth within the lesion. It was advised to the patient that she undergo removal of the cystic lesion along with the impacted teeth present within it. She underwent enucleation of the cyst followed by extraction of the impacted teeth in the region. Her swelling subsided and she remained free of symptoms for the next six to seven months. She then noticed a swelling developing in that region again. Evaluation by the same dentist revealed that the cyst had recurred in the region again. It had also become quite extensive at this point. The dentist explained that she needed to undergo surgical removal of the cyst followed by jaw reconstruction at a specialty center. It was also explained that this did not come under the purview of orthognathic surgery. He then referred her to Balaji Dental and Craniofacial Hospital, Chennai, which is a renowned center for cyst removal surgery in India. It is a premier center for jaw reconstruction surgery in Chennai. What is a cyst? A cyst is a soft tissue sac that consists of a membranous lining. It can be filled with air, fluid and various other substances. It can occur almost anywhere in the body. There are many types of cysts. These include sebaceous cyst, ovarian cyst, primordial cyst, pilonidal cyst, dentigerous cyst, etc. Dentigerous cysts always occur in association with an unerupted tooth. They occur in the mandible and complete enucleation is the only treatment for this cyst. The cystic wall lining has to be completely removed to prevent recurrence of the cyst. Rehabilitation of patients who have undergone surgery for dentigerous cyst Any teeth associated with the cyst have to be extracted. Replacement teeth or artificial teeth are always required after the healing process has been completed. Removable dentures were most commonly used before the advent of dental implants. Long term success with dental implants would be possible only with maintenance of good oral hygiene. Implants last a lifetime if coupled with good dental care. Dr Branemark who revolutionized dental implants could have never imagined the implications of his discovery. The use of dental implants has made it possible for patients who lose a sizable portion of their jaws to diseases or trauma to lead fully normal lives. Adequate nutrition is a prerequisite for leading a healthy life and dental implants enable maintenance of a normal diet that includes all food groups. Initial presentation at our hospital Dr SM Balaji, facial reconstruction surgeon, examined the patient and obtained a detailed history from her. He then ordered comprehensive diagnostic studies including a 3D CT scan. The patient had a swelling involving the left mandible. The 3D CT scan revealed a cystic lesion in that region that extended from lower right lateral incisor to the left lower third molar. There was also evidence of perforation of the lingual cortex of the mandible. Treatment planning was explained in detail to the patient who agreed to the plan and signed the informed surgical consent. It was planned to remove the lesion through a marginal resection along with extraction of the involved teeth to prevent recurrence. It was also planned to reconstruct the resultant bony defect in the mandible through the use of a costochondral graft that would be harvested from the patient. Patient undergoes successful removal of cyst followed by jaw reconstruction Under general anesthesia, two costochondral rib grafts were first harvested from the patient through a right inframammary incision. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity following which the incision was then closed in layers with sutures. This was followed by placement of a crevicular incision in the mandible following which a mucoperiosteal flap was elevated. The region of the mandible with the cystic lesion was then identified and exposed. Teeth overlying the cystic lesion were then extracted followed by marginal resection of the bone. The impacted third molar, which had been identified in the imaging studies was then extracted without incident and diathermy was then applied to cauterize all bleeding points. Reconstruction of the bony defect caused by removal of the cystic lesion was then performed. The costochondral rib grafts were crafted and shaped to fill in the bony defect. These were then fixed with titanium screws to the region following which the wound was closed with sutures. The patient would return in three to four months for dental implant surgery after consolidation of the rib grafts with the mandibular bone. Patient expresses satisfaction with results of surgery The patient expressed her total satisfaction with the treatment results before final discharge from the hospital. She will return in a few months for placement of dental implants. Permanent crowns will be placed on the implants once complete osseointegration of the implants with the bone has taken place, which would indicate completion of her rehabilitation following her cyst surgery. Surgery Video