Blog - Balaji Dental and Craniofacial Hospital

April 8th, 2019 10:21 pm April 8, 2019

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]

April 5th, 2019 05:19 pm April 5, 2019

smbalajiSurgery 331

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

April 4th, 2019 07:05 pm April 4, 2019

smbalajiSurgery 331

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

April 4th, 2019 12:16 pm April 4, 2019

smbalajiSurgery 331

Immediate Dental Implants for Smile Rehab

[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 ANDHRA PRADESH” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 32 year old school teacher from Andhra Pradesh, India approached our Dental Hospital seeking for a fixed replacement of her missing teeth. The patient gives a history of road traffic accident 5 years back. She experienced a traumatic fall which had knocked out her upper front teeth. In order to hide her dental defect, for the past 3 years patient was using the dental bridge given elsewhere after root canal treatment of the adjacent teeth.[/vc_column_text][vu_heading style=”2″ heading=”COMPLAINT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient complained that the dental bridge often got dislodged which hampered her speech and function. This eventually led to bad breath due to food getting stuck in between the bridge and the gums. Also, the patient stated that there was intermittent pain in her upper front teeth which increases on chewing. This affected the patient’s quality of life. She felt too timid to speak and smile. She was in need of a permanent solution to get back her good old smile.[/vc_column_text][vu_heading style=”2″ heading=”EXAMINATION ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, the dental bridge exhibited mobility. There was impaction of food and debris in between the bridge and the gums. The mobile dental bridge was removed and the condition of the teeth were evaluated. The tooth structure-supporting the dental bridge were broken and weak. Pre-operative full mouth x-ray taken indicated missing upper central incisors. There was incomplete root canal treated teeth on either side supporting the dental bridge owing to the pain stated by the patient earlier.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Treatment options like re-RCT of the teeth followed by traditional bridge was explained to the patient. However the patient was concerned and was not willing to go through the same process again. Also she was doubtful of its longevity. Hence considering the patient’s age and demand for a permanent fix, Dental Implants were opted. Dr.S.M Balaji, renowned Maxillofacial Surgeon and Implantologist, intended to place dental implants after extraction of the failed root canal treated teeth under local anesthesia. Patient’s consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”DENTAL IMPLANT PLACEMENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under local anesthesia, Dr SM Balaji extracted the broken teeth on either side of the upper arch. Following this, the gum tissue surrounding the corresponding site was raised exposing the underlying bone. Dental Implants of appropriate height were then placed in the empty tooth socket with stability. The implanted site was thoroughly irrigated with saline solution and closed with dissolvable suture. The patient was given medications for 5 days to cope with the mild swelling which eventually subsided. During the intervening time, a self cleansing provisional prosthesis was given to replace the missing teeth.[/vc_column_text][vu_heading style=”2″ heading=”POST TREATMENT FOLLOW-UP ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]It took a course of 3 to 4 months for the Dental Implants to completely integrate and harmonize with the jaw bone. Post operative OPG taken revealed well positioned dental implants in chime with the jaw bone. Subsequently, final bite trials were done. A natural looking, well-fitting fixed prosthesis was placed onto the implants in the upper jaw. The patient’s look elevated instantly. Her insecurities ceased! The prosthesis blended well with the adjacent natural teeth. She walked out with a dazzling smile! 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=”5664″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5665″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5666″ 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=”5667″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5668″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5669″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]

April 2nd, 2019 11:15 am April 2, 2019

smbalajiSurgery 331

Chin Tumor Excision Surgery

Patient develops an ugly growth on her chin This 24-year-old female from Arani, Tamil Nadu, India developed a pimple near the mole on her chin around two years ago. It initially appeared like a normal pimple; however, it did not stop growing, but continuously increased in size until it became a huge growth on her chin. This alarmed her because of its proximity to the mole on her chin. She visited many hospitals in her hometown, but no definitive diagnosis was made of this growth. This unsightly growth distressed her and she became reclusive because of this. She finally visited a cosmetic surgeon who diagnosed her growth as acne rosacea and referred her to our hospital for surgical excision of the growth. Our hospital is reputed for facial cosmetic surgery in India. What is acne rosacea? Acne rosacea is a persistent redness that appears in the middle face, which is usually related to abnormalities in the facial blood vessels. It is a benign inflammatory disorder, which affects around 45 million people worldwide. Not many with this condition are diagnosed as they just assume that they have very sensitive skin and learn to live with this often discomforting condition. It varies in its intensity in the same patient and waxes and wanes in severity. Acute exacerbation of this condition involves the appearance of inflammation and pimples. One of the signs and symptoms of this skin condition is the flushed appearance of the face. The blood vessels of the nose and the cheek are often visible and appear along with swollen red bumps. This can potentially be extremely bothersome and embarrassing to the patient and will worsen with time if left untreated. However, with prompt diagnosis and treatment, symptoms of this condition can be brought under control, allowing the patients to lead normal lives. Management of acne rosacea through the application of medications Those with this condition are also prone to pimples. Azelaic acid is sometimes prescribed to control the symptoms that arise from this condition. Side effects that can possibly arise from application of this medication include a stinging or a burning sensation, peeling of the skin and severe dryness. This belongs to a group of skin disorders that cause cosmetic compromise of the facial skin. Treating rosacea medically with the use of skin care products is the first line of treatment. Common signs and symptoms of the condition The American Association of Dermatology also advocates this treatment protocol for the treatment of acne rosacea. Pustulopapular rosacea involves eruption of pimples in the affected region that could get infected. Patients with rosacea usually learn to avoid triggers that exacerbate this condition like spicy food, alcohol, smoking, etc. Use of broad spectrum sunscreens does help keep the symptoms of this condition under control though there is no cure for this condition and it requires long term care. Surgical management of this condition falls under the purview of plastic surgery in India and is also performed by plastic surgeons. When the growth becomes excessive, it can be extremely disfiguring for the patient and intervention through surgical cosmetic procedures will lead to overall increase in the quality of the patient’s life. This condition predominantly affects the facial skin though it can also occur on the neck, chest, scalp or ears. People with rosacea usually have a history of easily blushing or flushing. A burning and stinging sensation can also accompany this condition. Initial examination and treatment planning at our hospital Dr SM Balaji, a renowned facial cosmetic surgeon in India, examined the patient and obtained a detailed history of the condition from the patient. He felt that the size of the lesion was too big to operate and decided to refer the patient to a dermatologist in order to bring down the size of the lesion to a manageable size before surgically excising it. This patient’s condition was extreme necessitating surgical removal. Medical management is more than adequate usually for acne rosacea treatment. The patient was then referred to a dermatologist who prescribed medications for the same. This brought down the size of the lesion within manageable limits following which the patient again presented back at our hospital for follow up. The lesion had significantly reduced in size after two months and it was decided to proceed with surgery. Successful removal of the chin lesion through surgery Under general anesthesia, the chin area was prepped thoroughly and a W incision was placed in the region of the lesion. Dissection was carried down to the subcutaneous tissues and the lesion was completely cleared from the region of the chin. The mole on her chin was also completely excised during this procedure. This was followed by closing the incision with fine sutures to minimize scar formation. Patient expresses happiness at the outcome of the surgery The patient was very happy with the outcome of the surgery. Her chin had been returned to its original dimensions and there was very minimal visible scar formation. She expressed her complete satisfaction with the results of the surgery and said that she could resume her old routines again as the removal of the lesion had helped restore the esthetics of her face thus boosting up her self-confidence. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

April 1st, 2019 01:39 pm April 1, 2019

smbalajiSurgery 331

Oblique Facial Cleft Secondary Rhinoplasty Surgery

The varying degrees of facial clefting Facial clefts are deformities of the face that are very rare and involve malformation of a part of the face. The etiology of facial clefts is still unclear though it is thought to be caused by failure of the fusion process during the development of the face. Genetics too is thought to play a role in the occurrence of facial clefts as the incidence of parents with facial clefts having children with facial clefts is quite high. There have also been instances where facial clefts have occurred in children with no family history of facial clefting. Facial clefting was studied in depth by Dr Paul Tessier who came up with the first classification of facial clefting. Dr. Paul Tessier is also considered to be the father of craniofacial surgery. Tessier’s classification of facial clefts ranges from 0-14. For example, Tessier cleft 0 bisects the maxilla and the nose. Children with these deformities would need multiple surgical procedures for rehabilitation of the defects. Patient born with cleft deformity and proboscis lateralis The patient is a 14-year-old boy from near New Delhi, India who was born with a cleft defect and proboscis lateralis. This involved gross deformity of the soft tissues of the nose. He was operated by a board certified plastic surgeon in Delhi shortly after birth for the cleft defect along with primary correction for proboscis lateralis. Cleft alveolar reconstruction/alveolar cleft defect reconstruction was also performed at the same hospital before he completed one year; however, the results of the plastic surgery were unsatisfactory and the patient has always been depressed about his facial deformities. What is proboscis lateralis? Proboscis lateralis is a congenital facial abnormality that is characterized by the presence of an incompletely formed rudimentary nasal appendage that is found in association with cleft lip defects. It is located off center to the vertical midline of the face. It is usually attached at the inner canthus of the eye and often associated with maldevelopment of the nasal cavity or paranasal sinuses of the affected side. Proboscis Lateralis is also associated with other craniofacial abnormalities such as orbital anomalies, cleft lip/palate, frontal encephalocele, and holoprosencephaly. Parents seek surgical correction of the nasal deformity Seeing how this was affecting their son’s life, the parents took him to Kolkota for consultation with a plastic surgeon. After a thorough examination, the plastic surgeon explained to the parents that this was a complex deformity that had to be addressed by a maxillofacial surgeon who was also a facial cosmetic surgery specialist. It was explained to the parents and the patient that the surgery procedures that he would need would include reconstructive surgery and cosmetic procedures for nose reshaping. He then referred the patient to our hospital for surgical correction of his problem. Our hospital is renowned for cosmetic nose surgery in India. Patient presents to our hospital for treatment Dr SM Balaji examined the patient and ordered comprehensive imaging studies. A 3D CT scan was obtained to fully evaluate the extent of the defect. Clinical examination revealed that the patient had a depressed nasal bridge with a deformed nose. His right nostril was smaller in size. Treatment planning was formulated and explained to the patient. Rhinoplasty or nose job would be performed to correct the patient’s nasal defect. The nasal defect was planned to be repaired using a double decker rib graft, which would be held in place using wires. Size of the right nostril would also be increased by means of a triangular flap along with a Wier excision. Surgical correction of the patient’s nasal deformity Under general anesthesia, rib grafts were first harvested through a right inframammary incision. This was followed by a Valsalva maneuver to ensure that there was no perforation of the thoracic cavity. The incision was then closed in layers. A midline nasal incision was then made and dissection was done up to the dorsum of the nose. The nasal bridge was then augmented using a rib graft followed by placement of a strut graft. A Wier excision was done on the right side. A triangular flap was raised from the right nasolabial region to increase the right nostril size following which the incision was closed with sutures. The patient and his parents were extremely happy with the results of the surgery and expressed their complete satisfaction before final discharge from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

March 29th, 2019 09:04 pm March 29, 2019

smbalajiSurgery 331

Immediate Dental Implants for Discolored Periodontally Compromised 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=”COMPLAINT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 53 year old male patient from Trivandrum, Kerala, approached our Dental Hospital seeking solution for his discolored, mobile lower front teeth. The mobility of the teeth made it difficult for the patient to speak and chew food. Also the patient stated that he’s a public speaker in a reputed organization. The discoloration of the teeth had compromised the speaker’s ability to smile and talk confidently. The patient requested for a cosmetic makeover of his teeth.[/vc_column_text][vu_heading style=”2″ heading=”EVALUATION” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, there was severe tartar around the lower front teeth due to poor oral maintenance. Also the teeth exhibited grade II mobility with gum recession. The gum tissue surrounding the teeth were swollen and red. A full mouth x-ray (OPG) taken indicated missing lower right central incisor. This led to pathological migration of the adjacent teeth which in turn created more gap between the lower front teeth. There was a significant amount of bone loss due to poor oral hygiene. Complete blood investigation revealed no systemic abnormalities.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Renowned Maxillofacial surgeon and Implantologist, Dr. SM Balaji examined the patient and planned to extract the compromised teeth followed by immediate dental implant placement under local anesthesia. Procedure was made clear to the patient and consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”PROCEDURE” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under local anesthesia, Dr.SM Balaji extracted the mobile lower front teeth. The gum tissue surrounding the lower front teeth were slightly raised. Immediate dental implants of appropriate height are then placed in the empty tooth socket with utmost stability. The relative site is closed with dissolvable suture. Since primary stability was achieved and also considering the patient’s designation, a self- cleansing light weight temporary fixed prosthesis was given to replace the missing teeth. The patient was very happy to get a temporary fixed prosthesis, as he was able to speak and function well for the time being.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT FOLLOW UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient reported back after 3 months for permanent prosthesis. This healing period of 3 months is to allow the dental implants to completely osseointegrate with the jaw bone. Post-operative OPG taken after the healing period showed well positioned osseointegrated dental implants. Final impression was taken and bite trial seen. Later the patient was given a fixed ceramic prosthesis over the implant. The patient was very much happy with the makeover. It blended well with the adjacent teeth giving him an elevated look. It took his confidence to a next level.[/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=”5643″ img_size=”full” add_caption=”yes” onclick=”zoom”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5644″ img_size=”full” add_caption=”yes” onclick=”zoom”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5645″ img_size=”full” add_caption=”yes” onclick=”zoom”][/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=”5646″ img_size=”full” add_caption=”yes” onclick=”zoom”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5647″ img_size=”full” add_caption=”yes” onclick=”zoom”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5648″ img_size=”full” add_caption=”yes” onclick=”zoom”][/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=”5649″ img_size=”full” add_caption=”yes” onclick=”zoom”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][/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]

March 25th, 2019 08:01 pm March 25, 2019

smbalajiSurgery 331

Orbital Tumors Excision Surgery – Two way Approach (Subcranial and Orbital)

History of multiple surgeries for a right eye deformity The patient is a 38 year old male from Virajpet in India who first noticed a swelling that was gradually causing his right eye to become displaced outwardly around ten years ago. This had begun as a small swelling near his right eye with a gradual increase in size. The swelling had gradually grown in size to the point that the patient developed double vision. His day to day activities of daily living began to get disrupted and this was beginning to affect his work as well as family life. It was at this point that he decided to seek medical help. Initial treatment history for the deformity He sought medical help for the first time around ten years ago at a hospital near his hometown for this gradually developing swelling. Comprehensive imaging studies including CT scans had been obtained and a bony growth was noticed in the right orbital cavity. Subsequently, he had undergone two surgeries to address this condition at that same hospital. The first surgery was through a bicoronal approach and the second was performed through the use of an endoscope. Both surgeries however were unsuccessful in addressing his complaints and he subsequently developed a severe infection in the area after surgery. Healing of the surgical site had been delayed due to the infection. This was a very difficult period for him and his family as he was not able to work during this entire phase. He was also ultimately not satisfied with the results of the two surgeries and was beginning to go into a depression because of his deteriorating vision. Referral to our hospital for management of his problem It was then that he approached an oral and maxillofacial surgeon in his hometown. Realizing that this was also a craniofacial problem, the surgeon referred him to our hospital for definitive management of his problem. Our hospital is renowned for facial asymmetry surgery and craniofacial surgery in India. Cranial deformity surgery is performed routinely at our hospital for syndromic patients with Apert’s, Crouzon, Franceschetti and other syndromes that cause craniofacial deformities. A center of excellence in craniofacial surgery Craniofacial surgery is a superspecialty, which deals with surgical correction of deformities of the craniofacial skeleton including facial deformities. One of the aims of surgical correction of facial deformities is to establish facial symmetry for the patient. Craniofacial surgery also involves components of plastic surgery. Many syndromes like Pfeiffer syndrome present with premature fusion of the coronal suture, sagittal suture and lambdoidal suture. These cause abnormal shapes to the top of the head leading to an abnormally shaped head. A skull deformity like posterior plagiocephaly can cause an abnormally shaped head amongst other deformities. This manifests itself in the infant skull itself and progressively gets worse with the passage of time. A molded helmet is fabricated for the patient to protect the skull during the healing phase after the surgery. Initial examination and diagnostic studies at our hospital Dr SM Balaji, Craniofacial Surgeon, examined the patient and obtained a detailed history. He then obtained a 3D CT scan to determine the exact extent of the bone disease. This revealed that there was overgrowth of the bone along the roof of the orbit and along the medial wall, which was pushing outwards and causing vision changes. The bony overgrowth appeared glass like and was diagnosed as ossifying fibroma. Our hospital is also renowned for ossifying fibroma surgery. What is ossifying fibroma? Ossifying fibroma is a benign fibroosseous lesion of the jaw that is very rare in occurrence. Normal bony tissue is replaced by fibrous tissue. This lesion is well demarcated from normal bony tissue and this is what differentiates it from fibrous dysplasia. Most common site of occurrence is in the craniofacial bones. It less commonly involves the maxilla, orbit or the paranasal air sinuses. Ossifying fibroma occurs in two histological patterns, trabecular or psammomatoid. Irrespective of the histological pattern, ossifying fibroma can induce a substantial degree of orbital inflammation. This must thus be included in the differential diagnosis for acute orbital inflammation. In the case of this patient, there was an overgrowth of fibrous bone extending into the roof the right orbit and also to the base of the skull up to the hypophyseal fossa. This excessive fibrous tissue had compressed the optic nerve thus resulting in blurred vision. Meticulous treatment plan formulated and explained to the patient A 3D stereolithographic model was obtained using the 3D CT scan. The exact extent of the bony overgrowth was determined extending into the intracranial regions and this was carefully marked. The planned surgery was explained in detail to the patient who agreed to the treatment plan and signed the informed consent. It was planned to approach the bony overgrowth through the bicoronal approach through which it would be removed from the roof and medial wall of the orbit, thus returning the eye back to its normal position. Successful completion of the surgical procedure Under general anesthesia, an incision was made through the old bicoronal flap scar to avoid any new scar formation. The right frontal craniotomy defect with the mesh was exposed and the mesh removed. A lumbar puncture was made following which CSF was drained to reduce the intracranial pressure. Dura was then retracted and the intraorbital whitish bony hard tumor was trimmed. An osteotomy was next performed over the roof and along the medial wall of the orbit. The bony overgrowth was then excised completely and this resulted in complete correction of the proptosis without any damage to the optic nerve. Pupillary function was then assessed and found to be normal. The frontal bone flap was then placed back in position followed by a titanium mesh over the bony defect. Skin closure was obtained through the use of skin staplers. Patient expresses his complete satisfaction before discharge from the hospital The patient was very happy with the outcome of the surgery as the results were immediate. The proptosis...

March 22nd, 2019 05:51 pm March 22, 2019

smbalajiSurgery 331

Replacement of Fractured Tooth with Dental Implant

[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=”COMPLAINT ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 21 year old young medical student from Chennai rushed to our Dental Hospital with lacerated gum tissue and uprooted upper left front tooth. Patient reported to have had an accidental fall at her house a couple of hours back. The traumatized area was profusely bleeding, also the patient was in immense pain. The pain was so awful that the patient requested on an immediate solution to bring her out of the agony.[/vc_column_text][vu_heading style=”2″ heading=”CLINICAL & RADIOLOGICAL EXAMINATION ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination, there was a significant amount of swelling on the patient’s upper lip. The upper left front tooth had been displaced and mobilized. Also the gum tissue surrounding the relative site had been teared from the traumatic fall. OPG (full mouth x-ray) taken revealed horizontal root fracture of the upper left front tooth. No pathological findings seen on the surrounding tooth structure. No signs of bone fracture.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Treatment option of stabilizing the fractured tooth with a rigid wire followed by observation of the tooth for 3 to 4 weeks was explained to the patient. As the patient was young and conscious esthetically, she demanded immediate correction of the fractured teeth. She requested for a permanent solution as she was planning to attend an upcoming event in a couple of months. Considering the patient’s age and need, renounced maxillofacial surgeon and Implantologist, Dr. SM Balaji decided to extract the fractured tooth followed by immediate dental implant placement under local anesthesia. The patients age and adequate bone level was ideal for a dental implant as the bone tends to repair rapidly when compared to a much older patient. A thorough blood investigation revealed no underlying abnormalities. The treatment plan was explained and patient’s consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”IMMEDIATE DENTAL IMPLANT PLACEMENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under local anesthesia, Dr. SM Balaji extracted the fractured upper left front tooth. The lacerated gum tissues were raised. Dental implant of adequate height was carefully placed with precision. The gum tissues were cleaned with saline and closure was achieved with dissolvable suture. Post operative OPG shows well positioned implant at the relative site.[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT FOLLOW UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient was under antibiotics and painkiller for 3 days to cope up with the moderate swelling and discomfort. Patient had to wait for a healing period of 3 months for the bone to osseointegrate with the implant. Meanwhile a removable prosthesis was given to the patient as it would look aesthetically unpleasant without upper front teeth. Eventually after a duration of 3 months, a fixed ceramic prosthesis was placed over the implant. The ceramic prosthesis blended well with the adjacent teeth giving her a natural alluring look. The patient was extremely happy with the outcome . She walked out with a ravishing smile. Patient had been on regular follow up over a period of 3 years[/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=”5630″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5631″ 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=”5632″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/2″][vc_single_image image=”5633″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]

March 19th, 2019 12:46 pm March 19, 2019

smbalajiSurgery 331

Upper Jaw Tumor Resection Surgery- Partial Maxillectomy

[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 presents with swelling in the left side of the face” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This is a young man from Guwahati in India who had noticed a slowly developing intraoral swelling on the left side of his face. Soft tissue distortion has been present with loss of facial symmetry and development of an asymmetric face. It has now been present for about six months now. He had visited a local dentist to get it checked. The dentist had said that the growth looked peculiar and referred the patient to a local oral and maxillofacial surgeon. Upon examination, the surgeon realized that the patient needed biopsies and management at a maxillofacial surgery hospital and referred the patient to our hospital for further management of his condition. Our hospital is a premier center for facial asymmetry surgery and jaw reconstruction surgery in India. We are a multispecialty hospital where comprehensive oral surgical care is offered for all conditions affecting the oral cavity and face. Corrective jaw surgery aligned with orthodontic treatment is also a specialty at our hospital.[/vc_column_text][vu_heading style=”2″ heading=”Patient presents to our hospital for definitive management of his condition” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji, facial reconstruction surgeon, examined the patient and obtained a detailed history. It emerged that the patient has been using tobacco for the past 12 years and had also been chewing pan for the past 10 years. The patient mentioned that the swelling started around six months ago and has since been gradually increasing in size. Upon examination, the patient’s swelling was completely painless and asymptomatic. He stated that he started getting worried only when someone said that it could be cancerous in nature and decided to seek medical help. He had immediately quit chewing pan at that point.[/vc_column_text][vu_heading style=”2″ heading=”Comprehensive investigations ordered for the patient” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Comprehensive clinical and radiological evaluation was performed on the patient. The patient’s swelling was in the left posterior maxillary region and was firm to the touch. Radiological studies including an OPG and a 3DCT scan revealed that the lesion extending from the left lateral incisor to the first molar along with involvement of the hard palate. A biopsy was obtained from the lesion, which revealed it to be a central giant cell granuloma.[/vc_column_text][vu_heading style=”2″ heading=”What is a giant cell granuloma?” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A giant cell granuloma is a rare bony lesion that occurs in the head and neck region, usually in the second and third decades of life. This rarely occurs after 30 years of age. It is a non-odontogenic tumor that is never seen in any other bone of the skeleton. Etiology is unknown though some consider it to be a reactive process secondary to trauma or inflammation. It is twice as common in females as it is in males. Literature review reveals that there have been instances where it has resolved spontaneously; however, early diagnosis of the lesion is ideal and treatment should be initiated immediately once diagnosis has been confirmed to limit the destruction of bone. It affects the maxilla more than the mandible. The mandible is always affected anterior to the first molar. It crosses over the midline when involving the mandible. Although benign, it can be locally destructive. Histological analysis of the lesion is necessary to arrive at a definitive diagnosis for central giant cell granuloma. Plastic surgeons also deal with these cases.[/vc_column_text][vu_heading style=”2″ heading=”Treatment planning explained to the patient in detail” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]It was explained to the patient that he needed surgical intervention to correct his problem. Surgery would involve complete removal of the lesion; however, immediate reconstruction was not advised keeping in mind the nature of the lesion. The need for bone grafting and dental implants will be determined at the time of surgery. Any impacted wisdom teeth will also be extracted at the time of surgery. Jaw joint function would not be disturbed by this surgery.[/vc_column_text][vu_heading style=”2″ heading=”Surgery performed on the patient with successful outcome” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under general anesthesia, an incision was made in the left maxillary region followed by elevation of a mucoperiosteal flap. The extent of the lesion was identified following which bone cuts were made from the anterior aspect of the lesion to the posterior extent of the lesion. This affected segment of bone was then removed following which a partial maxillectomy was performed. The wound was then closed with sutures. The patient was extremely relieved that the swelling had been removed. He was assured that the lesion would not recur as it had been excised with wide margin of normal bone. This ensured that the entire lesion had been removed. The patient was very happy with the outcome of the surgery and stated that he would return after a period of about 3- 4 months for reconstruction of the resultant maxillary defect.[/vc_column_text][vu_heading style=”2″ heading=”Surgery Video” subheading=”” alignment=”left” custom_colors=”” class=””][vc_video link=”https://youtu.be/8RlCtQr0ar0″][/vc_column][/vc_row][/vc_section]

Dental Implant and Ceramic Prosthesis for Fixed Replacement of Missing Teeth

Comminuted Zygomatic Bone Fracture ORIF Surgery

Large Dentigerous cyst excision and reconstruction with rib graft

Immediate Dental Implants for Smile Rehab

Chin Tumor Excision Surgery

Oblique Facial Cleft Secondary Rhinoplasty Surgery

Immediate Dental Implants for Discolored Periodontally Compromised Teeth

Orbital Tumors Excision Surgery – Two way Approach (Subcranial and Orbital)

Replacement of Fractured Tooth with Dental Implant

Upper Jaw Tumor Resection Surgery- Partial Maxillectomy

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