Cleft lip and palate deformities in antiquity Cleft lip and palate were viewed differently by different cultures. Some cultures were more accepting while others outright rejected infants born with these deformities. Chinese doctors in antiquity had developed ingenious ways to conceal cleft defects and many infants born with cleft defects grew up to become fully integrated in adult society. However, in ancient Greece, these children were considered to be from the devil himself and were abandoned in the forest to die. As scientific knowledge grew gradually with the advent of scientific thought, these deformities came to be better understood and society became more accepting of people born with these deformities. Patient with surgically corrected unilateral cleft lip and palate This patient, who is 16 years of age, is from Solapur, India. He was born with unilateral cleft lip and palate. This had resulted in a deformed upper lip and upper jaw. Surgical repair was planned for his condition. He had undergone cleft lip surgery elsewhere when he was 4 months old and cleft palate repair when he was 12 months old. An alveolar cleft reconstruction surgery was then subsequently performed when he was 7-1/2 years old. All the surgeries were performed in his home state of Maharashtra. Cleft palate usually requires orthodontic treatment of permanent teeth. These surgeries are also performed by board certified plastic surgeons in Western countries, but are performed by oral and maxillofacial surgeons in countries like Japan, China, India, etc. This is one of the most common congenital birth defects seen around the world. Surgical procedures to correct these defects have been developed over the years to give very good esthetic results for the patient. There is a higher incidence of cleft lip and palate in children born to parents with cleft lip and palate. Ear infections and hearing problems can also be more common in children with cleft deformities. Speech difficulties faced by the patient all his life He had always had difficulty conversing clearly with air escaping through his nose while speaking. He had approached an oral surgeon at his hometown for a solution to his problem. The oral surgeon had examined him thoroughly and had explained that he needed a sphincter pharyngoplasty for correction of his problem. He had further explained that this was a procedure that needed to be performed at a specialty cleft lip and palate center and had referred him to our hospital for management of his problem. Our hospital is renowned for cleft lip and palate surgery along with pharyngoplasty surgery in India Initial presentation at our hospital for treatment Dr SM Balaji, pharyngoplasty surgery specialist, examined the patient in detail. He conducted a speech assessment test and confirmed that the patient had velopharyngeal insufficiency. The patient’s speech had a nasal twang and there was escape of air to his glottis. Following this, a complete clinical and radiological evaluation was done. It was explained to the patient that correctional surgery yielded best results before 3-1/2 years of age, but since it had been performed only at 7-1/2, the results of the surgery would not be optimal as performed at 3-/1 years. Velopharyngeal insufficiency (VPI): Velo refers to the velum or soft palate. It is the part of the roof of the mouth that moves with vocalization of the “ah” sound. Pharyngeal refers to the throat (pharynx). During vocalization of certain sounds, the palate rises to touch the back of the throat and sends the air out of the mouth. In a person with velopharyngeal insufficiency, the soft palate does not contact the throat during speech, which results in escape of air through the nose. This causes a great deal of inconvenience to the patient as their speech is not easily discerned by others. Treatment planning for correction of the patient’s complaint It was decided to perform a sphincter pharyngoplasty to correct the patient’s problem of air escaping into the nasal cavity during speech. This surgery is performed under general anesthesia. Flaps of tissue from behind bilateral tonsils are connected across the back of the throat. This narrows down the throat opening, leaving just a small central opening or port in the middle for breathing through the nose. A positive suction test was performed at the conclusion of the surgery to test for proper seal. There was elevation of the soft palate thus confirming successful outcome to the surgery. Successful outcome for the surgery Improvement in the patient’s speech was dramatic and immediate after surgery. The patient was very happy with the outcome of the surgery and expressed his complete satisfaction at the results. As for his speech problems, the patient will later be referred for speech therapy for further improvement in his speech. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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