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Fibrous Dysplasia of the Upper jaw and Cheekbone (maxilla and zygoma) surgery

[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=”Development of a facial swelling in a patient from Mizoram, India” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This is a 23-year-old patient from Mizoram, India who first noticed the swelling on the left side of his face about four months ago. He chose to ignore it as it did not cause him any pain; however, the swelling continued to slowly increase in size and this began to make his face feel heavy. It also caused disfigurement of his facial features, which began to distress him. This facial asymmetry began to make him feel self conscious while interacting with others and he slowly began to avoid social interactions with other people. He is a student and this began affecting his studies. His parents became alarmed as he also seemed to have lost his usual self confidence.[/vc_column_text][vu_heading style=”2″ heading=”Initial assessment by a local surgeon in his hometown” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]They took him to a local surgeon who examined him and obtained imaging studies. Upon viewing the images, he explained to them that there was an overgrowth of bony tissue at the site of the facial swelling and that it had to be addressed immediately. He said that it could be corrected only through surgery. The patient was then referred by the surgeon to Balaji Dental and Craniofacial Hospital in Chennai, which is a renowned center for facial asymmetry correction surgery in India as well as being a center of excellence for facial reconstruction surgery. Board certified plastic surgeons as well as oral and maxillofacial surgeons treat this condition in western countries.[/vc_column_text][vu_heading style=”2″ heading=”Patient presents at our hospital for surgical management of facial asymmetry” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji, facial cosmetic surgeon, examined the patient and obtained a detailed history. It emerged that the swelling developed insidiously and that the patient did not have any symptoms accompanying the development of the swelling. He then ordered comprehensive imaging studies for the patient. The 3DCT revealed that the patient had bony overgrowth in relation to the left zygomaticomaxillary complex. It went up to the outer border of the left orbit and was also seen to involve the left maxillary sinus and base of the skull. The growth was diagnosed as fibrous dysplasia.[/vc_column_text][vu_heading style=”2″ heading=”What is fibrous dysplasia?” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Fibrous dysplasia is a disorder where normal bone and marrow is replaced with fibrous tissue. It often affects the head and neck region. This causes formation of bone that is weak and prone to fractures and deformity. The abnormal excessive fibrous bone can extend into the orbital cavity and paranasal air sinuses or lead to compression of nerves such as the optic nerve, thus causing impairment of normal function and pain in the affected region. It can either involve only one bone or can involve multiple bones. Involvement of multiple bones can lead to a serious compromise in the patient’s quality of life. Fibrous dysplasia can also occur in isolation or can occur in combination with other diseases. Treatment of extensive fibrous dysplasia is akin to reconstructive procedures.[/vc_column_text][vu_heading style=”2″ heading=”Comprehensive treatment planning for the patient” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient and his parents were counseled regarding the treatment of fibrous dysplasia. It was recommended that the patient undergo complete reduction of the fibrous dysplasia; however, the patient was very specific that he wanted only cosmetic correction of his facial deformity and was not willing for any other major surgical procedures. All the pros and cons of his decision were explained to the patient and his parents in detail and they consented to cosmetic reduction of the fibrous dysplasia.[/vc_column_text][vu_heading style=”2″ heading=”Successful surgical correction of the patient’s facial asymmetry” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient’s fibrous dysplasia lesion was approached through a crevicular incision that was made in the left maxilla. A mucoperiosteal flap was then elevated and the fibrous bone exposed. This fibrous overgrowth of bony tissue was then meticulously reduced to normal dimensions in the region of the left zygoma, zygomatic arch, nasal bone, maxilla, pterygomaxillary region and lower, medial and lateral borders of the left orbital rim. Reduction of the bony overgrowth was carried out until the bone was symmetrical to that on the right side of the face. The incision was then closed with sutures.[/vc_column_text][vu_heading style=”2″ heading=”Patient and parents express their satisfaction at surgical results” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Complete facial symmetry was established and the patient regained his old facial features. He was very satisfied with the results of the surgery and expressed his satisfaction at the end of the surgery.[/vc_column_text][/vc_column][/vc_row][/vc_section]

Read moreFibrous Dysplasia of the Upper jaw and Cheekbone (maxilla and zygoma) surgery

Immediate Dental Implant followed by cyst removal and bone graft

[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 SCENARIO ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 29 year old patient from Assam, India came to our Dental Hospital seeking solution for his painful mobile upper front teeth. Patient gives a history of root canal treatment done for his upper anterior teeth in a single appointment done elsewhere. However the patient had his teeth re-treated twice after the earlier root filling had been unsuccessful. But over a period of time, the patient experienced pain and swelling with pus formation in the related teeth. To provide relief for the patient, doctor’s elsewhere have performed an Apicectomy (removal of root apex of a teeth along with the infected lesion to prevent further infection). That did not stop the teeth from getting infected again. Patient continued to suffer with pain and discomfort. Dejected by unsuccessful procedures performed by doctor’s elsewhere, patient ended up in Chennai to our hospital seeking for a permanent solution.[/vc_column_text][vu_heading style=”2″ heading=”CLINICAL & RADIOLOGICAL INVESTIGATION ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]On clinical examination the upper anterior teeth were mobile and patient experienced pain on palpation. The gums surrounding the related teeth were swollen with accumulation of pus. A sinus tracing was done with a gutta percha to find the source of infection. A full mouth x-ray (OPG) taken revealed a well-defined radiolucency at the tip of the upper front teeth indicating a periapical cyst. A thorough blood investigation revealed no underlying systemic disease[/vc_column_text][vu_heading style=”2″ heading=”TREATMENT PLAN AND CONSENT ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]After thorough examination of the patient, Maxillofacial Surgeon and Implantologist, Dr. SM Balaji, planned to completely remove the cyst by extracting the infected teeth under general anesthesia. Followed by the healing period, Dental implant placement under local anesthesia was planned. The patient was explained about the surgical procedure and consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”SURGICAL PHASE (CYST REMOVAL) ” subheading=”” alignment=”left” custom_colors=”” class=””][vu_heading style=”1″ heading=”STAGE 1 ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Before the surgical procedure, preparation of the patient was done. Once the patient was anesthetized, Dr.S.M.Balaji, extracted the infected upper front teeth along with the cyst without damaging the supporting structures. The remnants of the cyst were then scooped out completely, ensuring no recurrent cyst formation at that site in the future. The gingival tissue is then stitched with dissolvable suture.[/vc_column_text][vu_heading style=”2″ heading=”POST OPERATIVE FOLLOW-UP” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The surgery was a success. Patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. The patient was put on antibiotic treatment for a period of 5 days. The patient had to wait 3-4months for the bone at that site to regenerate and heal completely. Until then, a removable prosthesis was given to replace the missing teeth.[/vc_column_text][vu_heading style=”1″ heading=”STAGE 2″ subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Once integration of the bone was achieved and no traces of the recurrent cyst was ensured, Dr. SM Balaji, skillfully placed the Dental Implants in relation to 21 & 22 under local anesthesia. Patient had to wait for a healing period of 3 months for the implant to osseointegrate with the jaw bone. Patient continued on with the removable prosthesis.[/vc_column_text][vu_heading style=”2″ heading=”THE SATISFIED PATIENT” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Post operative OPG showed dental implants positioned with stability and in integration with the jaw bone. The patient was given a fixed ceramic prosthesis over the implant. It gave a natural well blended appearance. Patient was very happy to have had a permanent solution. It boosted his look and confidence. Patient has been on regular follow up for over 2 years.[/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=”5604″ img_size=”large” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5605″ img_size=”large” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5608″ img_size=”large” 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=”5606″ img_size=”large” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5610″ img_size=”large” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5611″ img_size=”large” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]

Read moreImmediate Dental Implant followed by cyst removal and bone graft

Fixed Ceramic Prosthesis for Unilateral Cleft Patient with Autogenous Graft

[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 SCENARIO ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This is a case of a 19 year old male patient from Sri Lanka with unilateral cleft lip and palate. He had his primary lip repair done at the age of 3 months and palate repair at the age of 9 months by the esteemed Maxillofacial Surgeon, Dr.S.M.Balaji in our Hospital. Followed by this the patient had undergone cleft alveolar bone closure surgery elsewhere. Later the patient reported to our hospital seeking correction for his malaligned teeth. The severe malocclusion compromised his oral function and appearance. Patient explained about his difficulty to chew food and that he was experiencing a stutter. The Sri Lankan patient was put under orthodontic treatment for correction of severe malocclusion. The orthodontic treatment was a success. The braces aligned his teeth and a proper occlusion was brought. But, the patient’s upper front teeth were severely rotated and mobile to be aligned orthodontically.[/vc_column_text][vu_heading style=”2″ heading=”RADIOLOGICAL INVESTIGATION” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]OPG (full mouth x-ray) and CBCT image (cone-beam computed tomography) taken revealed rotated upper left anterior teeth. There was incomplete root formation of the teeth. There was a significant amount of bone defect at the related site. Also the left lateral incisor seemed to be genetically missing. This deficient bone at that site indicated that the teeth cannot be corrected by orthodontic treatment. A thorough blood investigation revealed no underlying systemic abnormalities.[/vc_column_text][vu_heading style=”2″ heading=”PLAN AND CONSENT ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Complete radiological and dental evaluation of the patient was carried out. Patient was particular that he wanted a permanent solution for his problem. Alternative treatment like root canal followed by ceramic bridge placement was also explained. Yet the patient specifically demanded for Dental implants. Hence considering the patient’s age and need, maxillofacial surgeon and Implantologist, Dr.S.M.Balaji, planned to extract the related teeth followed by bone graft under general anesthesia and later Dental implant placement. In case of cleft bone defect, Autogenous graft (bone obtained from the same individual receiving the graft) taken from extraoraldonar site like chest (rib bone) or iliac bone (hip bone ) is usually used for closure of the defect. Since the bone defect is small, the amount of bone required to close the defect is only needed in a small proportion. Hence, the bone graft was planned to be harvested from the patient’s mandibular symphysis (chin bone) intraorally. Despite, recent advances in bone grafts and bone-substitute technology, Autogenous grafts have always been regarded to be the “gold standard” due to its properties and absence of immunological reactions. The thick symphyseal bone reduces resorption and helps in bone regeneration. The patient was clearly explained about the surgical procedure and consent was obtained.[/vc_column_text][vu_heading style=”2″ heading=”SURGICAL PHASE I ” subheading=”” alignment=”center” custom_colors=”” class=””][vu_heading style=”2″ heading=”Bone Defect Closure” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Before the surgery, preparation of the patient was done. Under general anesthesia, a full thickness gum tissue is raised in relation to the lower symphysis region. A small part of a bone was cut and taken out from the chin region .The bone graft is then kept in a saline medium. Closure of the gingival tissue in the lower jaw is achieved with dissolvable suture. Followed by this, a full thickness gum tissue is raised in relation to upper left anterior teeth. Dr.S.M.Balaji extracted the crooked teeth without damaging the surrounding structures. The autogenous bone graft is fixed in the bone defect by means of screws. The gingival tissue is then approximated with dissolvable suture.[/vc_column_text][vu_heading style=”2″ heading=”OUTCOME ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This bone augmentation procedure allows implant placement in an optimum position to get long term function. Also aids in predictable esthetic outcome for prosthodontic restorations.[/vc_column_text][vu_heading style=”2″ heading=”PATIENT FOLLOW UP 1″ subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patient was given a provisional prosthesis for a healing period of 3 months. Over a period of time the symphyseal bone rapidly regrows without altering the natural shape of the relative site. Hence there was no change in the soft-tissue contour of chin. Complete integration of the bone graft with the jaw bone was obtained.[/vc_column_text][vu_heading style=”2″ heading=”SURGICAL PHASE II ” subheading=”” alignment=”center” custom_colors=”” class=””][vu_heading style=”2″ heading=”Dental Implant placement ” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Bone formation at the grafted site was satisfied. Dental implant placement at the relative site under local anesthesia was planned. The gum tissue surrounding the upper left anteriors were raised. Implantologist ,Dr.S.M.Balaji, placed the Dental Implants in relation to 21,22 & 23 with utmost precision. Once the implants are in position cover screw is placed onto the implant. The gingival tissue is then closed with dissolvable suture.[/vc_column_text][vu_heading style=”2″ heading=”PATIENT FOLLOW UP 2″ subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient had to wait for a healing period of 3 more months for the Implant to completely osseointegrate with the jaw bone. Patient continued on with the removable prosthesis. Post operative OPG showed well positioned, osseointegrated implants at the related site. The patient was given a fixed ceramic prosthesis over the implants. Bite equilibration was achieved. The patient was overjoyed to have a complete smile makeover using dental implants. Also stated that he experienced an immediate change in his speech after placement of the prosthesis. Patient had been on regular follow up over a period of 2 years.[/vc_column_text][/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=”1/3″][vc_single_image image=”5588″ img_size=”large” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5590″ img_size=”large” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5591″ img_size=”large” 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=”1/3″][vc_single_image image=”5593″ img_size=”large” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5594″ img_size=”large” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5595″ img_size=”large” 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=”1/3″][vc_single_image image=”5597″ img_size=”large” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5598″ img_size=”large” add_caption=”yes”][/vc_column][vc_column layout=”normal” vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”5599″ img_size=”large” add_caption=”yes”][/vc_column][/vc_row][/vc_section]

Read moreFixed Ceramic Prosthesis for Unilateral Cleft Patient with Autogenous Graft

TMJ Ankylosis Wisdom teeth removal with fiber optic bronchoscope difficult intubation

What is ankylosis and what are its effects Ankylosis is the condition where bony joints exhibit extreme stiffness and rigidity due to fusion of the two opposing bones in the joint. It was coined in the 18th century from the Greek word Ankylosis, which means crooked. This condition causes extreme difficulty for the person affected by it. Ankylosis can affect any bony joint in the body. Ankylosis of the long bones can result in limitation of movement, thus causing mobility issues when involving the lower limbs and issues with functionality when involving the upper limbs. Debilitating effects of ankylosis of the vertebral column Ankylosis of the bones of the vertebral column can lead to extreme stiffness and in severe cases where there is calcification of the spinal cord can lead to paralysis, leaving the patient bedridden. Ankylosis is most often brought about by trauma to the joints though it can also be idiopathic in nature. Reduced life expectancy in the olden days due to ankylosis of joints Back in the olden days before the advent of modern medicine, people with ankylosed joints tend to have reduced life span because of the limitations brought about by this condition. They were accident prone because of lack of mobility and easily injured themselves from fall. Even minor abrasions and cuts suffered from fall could easily get infected before the advent of antibiotics, thus increasing the morbidity associated with ankylosis. Evidence of ankylosis in dinosaurs Ankylosis is a condition that has plagued living organisms even before the appearance of modern man on Earth. Fossil records indicate that this was a common condition amongst animals. Many dinosaur fossils have been excavated that exhibit signs of ankylosis of joints. The most famous specimen of the T. Rex that is on exhibit at the Black Hills Institute of Geological Sciences in Hill City, South Dakota exhibits evidence of ankylosis. History of ankylosis surgery down the ages John Benjamin Murphy was an American surgeon, born in 1857, who was the first to meet with reasonable success at performing ankylosis surgery. He was often referred to as the surgical genius of that generation. Dr Murphy is credited with many surgical firsts in general, orthopedic, cardiothoracic and neurosurgery. Dr Murphy’s breakthroughs with the use of bone grafts for ankylosis surgery He extensively researched the application of various types of bone grafts. One of the first to recognize the potential use of bone grafts in reconstructive surgery, he pioneered the release of ankylosed joints followed by the use of bone grafts and physiotherapy to aid in mobility of the joints. He dedicated his life towards the advancement of surgical frontiers and made many breakthroughs in surgical techniques in some many different specialties of surgery. He was awarded by the University of Notre Dame and the University of Sheffield for his dedication towards the surgical sciences. Ankylosis of the temporomandibular joint This is a condition where the TMJ fuses with the glenoid fossa. Ankylosis of the TMJ can either be fibrous or bony. Fibrous ankylosis is the condition where the fusion is through dense proliferation of fibrous tissue. Bony ankylosis happens when there is actual bony fusion of the TMJ with the glenoid fossa. The mandible becomes completely immobile in the case of bony ankylosis. Very minimal movement of the mandible can be elicited in the case of fibrous ankylosis. Etiology for ankylosis of the TMJ can either be infectious or traumatic. A trauma to the TMJ that is left unaddressed can result in ankylosis of the TMJ. Jaw deformity as a result of trauma to the chin as a little boy This now 14-year-old boy from Kangeyam, Tamil Nadu, India had suffered a fall on his chin when he was around 2 years of age. They had taken him to a local hospital where he had been given first aid and discharged. He had slowly developed difficulty opening his mouth and deviation of the jaw to the right side. His speech and feeding was also getting affected and his alarmed parents had taken him to a local oral surgeon as they knew that this was a problem that needed a dentist or oral surgeon. Diagnosis of ankylosis of right jaw joint as etiology of deformity Imaging studies had revealed an ankylosis of the right temporomandibular joint. Ankylosis of TMJ is a very debilitating condition. TMJ ankylosis surgery is performed only at a few specialized hospitals. The oral surgeon had explained the problem in detail to the boy’s parents. He had informed them that TMJ surgery in India was a very specialized procedure and had referred them to Balaji Dental and Craniofacial Hospital in Chennai. Oral surgeons are the specialists who treat this condition. Ankylosis release surgery performed successfully Surgery was performed on the boy and the ankylosis was released. However, the boy had developed micrognathia as a result of the long standing neglect and Dr SM Balaji had advised the parents that the boy needed mandibular distraction osteogenesis later. Maxillary distraction is not needed in this case. Wisdom teeth removal is essential before performing distraction osteogenesis. This is performed through the use of distraction devices. In this case, a internal distractor device would be used to unite the distracted bone segments. The bone removed during distraction can be used as bone grafts. Wisdom teeth can either be partially erupted (partially impacted) or fully encased (fully impacted) within the bone. Diagnosis of three impacted molars at the time of presentation for mandibular distraction The boy presented with his parents for scheduling his distraction osteogenesis. Imaging studies obtained at this time revealed that he had an impacted lower left third molar along with impacted right second and third molars. Parents were informed that these impacted molar teeth needed to be extracted before the distraction surgery. Tooth extractions needed to be performed under general anesthesia because of the associated conditions present in this case. Extreme care has to be taken to avoid dry socket. This can be ensured through maintenance of good blood...

Read moreTMJ Ankylosis Wisdom teeth removal with fiber optic bronchoscope difficult intubation

Lip Smile correction, Jawline augmentation and Temporal hollowing correction

Young woman with chief complaint of long face This young lady was not happy with the shape of her face. She complained that her upper lip was too long and her upper incisors were not visible when she smiled. She desired to have a shorter upper lip. Another complaint was that the sides of her face were very depressed and lacked adequate fullness. She also wanted a more prominent mandibular angle as she felt that her lower face was elongated. Extensive history of past cosmetic facial surgery The patient has undergone numerous surgeries in the past including a rhinoplasty, upper lip lift, eyebrow lift, cheek and jaw implants(Medpor) for which the mandible was shaved, advancement genioplasty, lower lip tissue deformity augmented with dermis/fat graft, Teosyal filler for dark circles and porcelain crowns. All these procedures had been performed elsewhere. She had been referred to our hospital as our hospital is renowned for facial cosmetic surgery in India. Growth of reconstructive surgery in India Reconstructive surgery or plastic surgery in India has undergone a boom due to medical tourism from all parts of the world. Facial plastic surgery is also performed by oral and maxillofacial surgeons in India. They had an in depth knowledge of the facial anatomy including the soft tissue and hard tissue anatomy. The incisions have to be performed in the correct tissue planes for the best surgical results. This will result in the incision scars blending in within the skin tone of the patient and becoming unnoticeable over a period of time. Some of the surgical procedures or cosmetic procedures performed by plastic surgeons in India include fat transfers, injectable fillers for enhanced lips, cosmetic correction of congenital defects and face lifts. Hyaluronic acid is one of the fillers used for lip enhancement surgery, which is often done under local anesthesia. Care has to be taken to have the patient tested for allergic reactions and side effects before use. Initial examination and investigations upon presentation at our hospital Dr SM Balaji, facial cosmetic surgeon, examined the patient and had in depth discussions with the patient regarding what the patient desired from her surgery. He then ordered imaging studies including a 3D CT scan. A 3D stereolithographic model of the patient’s skull was also obtained. The patient had significant bilateral temporal hollowing. Her angle of mandible on the left side appeared to be recessed. There was no maxillary incisor show during speech and smiling. The vermillion was inadequate at the left corner of the upper lip. He continued to conduct detailed discussions with the patient throughout this period and explained in detail about what the patient could expect from the surgery. Treatment planning formulated after detailed discussions with the patient He formulated a treatment plan that would best address the patient’s multiple complaints. Correction of the bilateral temporal hollowing would be through the utilization of rib grafts that would be harvested from the patient. This would be through a bicoronal incision as that would avoid any visible scarring for the patient. Augmentation of the left mandibular angle would also be through the use of a rib graft. He also planned to perform bilateral anguloplasty for the patient along with a lip lift using the bullhorn technique. Surgical correction of the patient’s cosmetic complaints Under adequate general anaesthesia, two rib grafts were obtained through a left inframammary incision following which a Valsalva manoeuvre was performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures. Following this, an incision was then made in the posterior region of the left mandible followed by elevation of a flap. The left angle of mandible was then augmented using the costochondral rib graft, which was fixed in place with titanium screws. This was followed by bilateral anguloplasty for smile line correction. A bullhorn procedure was then performed next to increase the show of upper incisors during smiling and speech. The bilateral temporal hollowing was addressed next. This was done through a bicoronal flap through a pre-existing surgical scar. There would be no visible scar formation through this approach. A frontotemporal flap was then raised. The region of the temporal hollowing was augmented bilaterally through the use of rib grafts, which were fixed using titanium plates and screws. Total patient satisfaction at the results of the surgery The outcome of the surgery was exactly as planned and the patient expressed her complete satisfaction at the final results of the surgery. She had about 3-4 mm incisal show following the bullhorn procedure and there was also increased vermillion exposure of the upper lip following the anguloplasty along with a more prominent angle of the mandible. She was very happy with the results of her cosmetic lip surgery. Surgery Video frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen>

Read moreLip Smile correction, Jawline augmentation and Temporal hollowing correction

Facial Feminization Surgery- Jaw Angle correction and short lip correction

An introduction into the evolution of human jaw size Men have a robust skeletal frame and women have a more delicate bone structure. Before the advent of civilizations, agriculture and community living, when man was a hunter gatherer, it was the men who went out to hunt for food. The prey of course did not like becoming food and these encounters often turned violent. Prey charging the hunters and the hunters suffering injuries or even dying was common occurrence. It was the men with more robust skeletons who better withstood the brunt of these often violent hunts and evolution took care of the rest in the form of genetic encoding. There are occasions when this genetic coding results in women developing prominent jaws, which gives them a masculine look. The advent of cosmetic surgery in recent times allowed these women to get their jaws sculpted by cosmetic surgeons to give them a feminine jaw. The following surgical procedure involves the reduction of jaw size in a young lady who presented with the complaint of prominent jaws. A young lady with complaints of a very prominent mandible and facial asymmetry This young lady from Chikmagalur in Karnataka had always felt that her mandible was too prominent. She also felt that she had a short lip. This had caused her to use scarves to conceal her mandible as she felt it was very masculine in appearance. A friend of hers had encouraged her to get it surgically corrected through surgery as that was affecting her day to day functioning. She had presented to a board certified plastic surgeon whose area of specialization include cosmetic surgery involving eyelid surgery, tummy tucks, skin grafting and breast augmentation surgery. This surgeon examined her and obtained various studies. He explained to the patient that a narrower mandible would make her face look longer and more feminine. She had also been involved in a road traffic accident that had resulted in facial injuries a year ago. She felt that this had aggravated her problem even more. Thus, she wanted to undergo surgical correction of her prominent mandible as a long term or permanent solution. She however did not have an open bite. She wanted more feminine facial features. The plastic surgeon had recommended to her that an oral and maxillofacial surgeon would be the right person to perform this corrective jaw surgery. He thus referred her to Balaji Dental and Craniofacial Hospital as we are renowned for facial cosmetic surgery and jaw reconstruction surgery. Our hospital rigorously adheres to the rules and regulations laid down by the American Association of Oral and Maxillofacial Surgeons. All cosmetic surgery procedures of the head and face are performed at our hospital. Treatment planning after initial evaluation and imaging studies at our hospital Dr SM Balaji, jaw reconstruction surgeon and a specialist in orthognathic surgery examined the patient. Orthognathic surgery is performed for patients with jaw size complaints. He obtained facial biometric studies and ordered comprehensive imaging studies for the patient. The 3D CT scan revealed that she had prominent masseter muscles bilaterally along with bimaxillary protrusion. He explained to the patient that she needed bilateral reduction of her masseter muscles, bilateral reduction of the angle of her mandible, Le Fort I osteotomy with anterior maxillary and supapical osteotomy. It was explained to the patient that this surgery would result in a narrower mandible, which would give her a longer facial profile and a feminine appearance. The patient and her parents expressed their desire to proceed and gave written informed consent for the surgery. Surgical correction of the patient’s prominent jawbone Under general anesthesia, an incision was first placed in the mandibular retromolar region on the right side. This was followed by elevation of a mucoperiosteal flap. The angle of the mandible was then accessed through this incision and the bone was reduced using a round bur. The periosteum was then dissected and the masseter muscle identified. This was then partially excised bilaterally. The same procedure was then performed on the left side. Correction of the patient’s prominent upper and lower jaws Following completion of the masseter and angle reduction, an incision was placed in the maxillary sulcus and mucoperiosteal flap elevated. Le Fort I osteotomy bone cuts were then made in the maxilla using a reciprocating saw. Pterygomaxillary dysjunction was then performed following which the maxillary segment was mobilized and pushed back. An anterior maxillary osteotomy was then performed and the anterior maxillary segment was pushed back. Occlusion was then checked and the bone was stabilized and fixed in place using titanium plates and screws. Following this, a sulcular incision was made in the anterior mandible and mucoperiosteal flap elevated. Bone cuts were then made below the apices of the teeth using a reciprocating saw and the anterior mandible was set back. The mandibular segment was checked for occlusion and fixed using transosseous wires. Hemostasis achieved and closure done with suction drain in place. Patient and parents fully satisfied with the results of the surgery The patient was very pleased with the results of the surgery. She liked the new tapered appearance to the face, which was the result of the narrowing done at the angle of the mandible. She also was very happy with the appearance of her lips and her new facial profile. She had a correct bite and her occlusion was perfect. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Jaw Fracture Surgery – Comminuted Fracture of the ramus of Mandible internal fixation

Mandibular fracture in a young man after road traffic accident The patient is a 25-year-old IT professional who was brought by his parents to Balaji Dental and Craniofacial Hospital after a road traffic accident. He had been riding his bike to work when a speeding car rear-ended his bike at a traffic signal. The impact was sufficient enough to make him lose his balance and he fell with his chin impacting the road directly. He felt intense pain with grating noises upon trying to speak. He was not wearing his helmet at the time of the accident. Onlookers at the site of the motor vehicle accident informed his parents who immediately arrived at the scene. The patient also suffered minor facial injury from direct facial trauma. Helmet wearing is scientifically proven to protect the head during accidents This accident clearly demonstrates the safety value of wearing a helmet when riding a two wheeler. Though the patient’s accident was relatively minor, he suffered quite a severe injury with two fractures of his mandible requiring open reduction and internal fixation. Just the simple act of wearing a helmet would have saved him the grief of undergoing major surgery for his fractures. It should be noted that wearing a helmet without strapping it under the chin would essentially be useless as the helmet would get dislodged from the head at the time of impact. Emergency treatment administered to the patient at a nearby hospital The patient was taken immediately to a nearby hospital where first aid was administered for the minor skin lacerations and abrasions he had sustained on his body and face. A tetanus toxoid injection was also administered as the wounds had been contaminated with road debris along with broken bone. The patient was then referred to our hospital for further management as our hospital is well known for facial fracture surgery in Chennai. Initial consultation and radiographic studies for diagnosis Dr SM Balaji, facial fracture surgeon, examined the patient thoroughly. The patient was unable to provide a verbal history because of inability to move his mandible. He then ordered imaging studies including OPG and a 3D CT for the patient. These revealed that the patient had a displaced fracture of left body of mandible, a fracture of the left lower second premolar and non-displaced right mandibular ramus fracture extending up to the coronoid process. Luckily, there were no fractures to other facial bones other than the mandibular fractures. For example, orbital fractures to the orbital rims with involvement of the eye sockets, condylar fractures, upper jaw or nasal fractures would have complicated the treatment manifold. Treatment planning explained in detail to the patient It was explained to the patient and his parents that the fractured lower left second premolar could not be saved and had to be extracted. This would be followed by open reduction and internal fixation of the patient’s mandibular fractures. Closed reduction would not be possible due to the severity of the fractures. Classification of treatment of fractures broken down into basic essentials consists of open reduction and closed reduction. Open reduction of fractures is for complex fractures that need to be stabilized with plates and screws. Closed reduction is for favorable fractures that can be stabilized by immobilization of the fracture site. It was explained that the entire mandibular fracture surgery would be performed through an intraoral approach to avoid scar formation. They were also informed that the patient’s jaws would be wired shut for a period of two to three weeks to help with the healing process and that he would not be able to open his mouth during that period. He was also advised to take a liquid diet for about 2-3 weeks followed by a semi-solid diet. The patient and his parents were in complete agreement with the treatment planning and a written consent was obtained from the patient. Successful reduction of the mandibular fracture with titanium plates and screws Under general anesthesia, an arch bar was first fixed to the maxillary and mandibular arches. An incision was then made in left lower mandible to access the fracture site. The fractured left lower second premolar was extracted. Fractured segments of the mandibular bone were then reduced. Occlusion was checked and the bone segments were stabilized and fixed with titanium plates and screws. Following successful reduction of the fracture on the left side, an incision was then made in the right mandibular sulcus. A flap was raised and the fractured segments were identified. These segments were then stabilized and fixed with titanium plates and screws. Occlusion was checked again and was found to be normal. Care was taken to avoid damage to the inferior mandibular nerve throughout the procedure and there was no nerve damage at the end of the procedure. The patient tolerated the procedure well and recovered uneventfully from general anesthesia. Successful results with patient expressing complete satisfaction The patient and his parents expressed their satisfaction at the outcome of the surgery. Intermaxillary fixation was done postoperatively and would be removed after a period of three weeks. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Atrophic upper jaw graftless Dental implant surgery | Zygomatic Implant

Discovery of osseointegration of titanium with living bone Dr Per Ingvar Branemark, a Swedish medical researcher, had placed titanium implants in the bones of rabbits for an experiment; however, when he tried to remove the titanium implant from the bone, he found that it had become as one with complete fusion of the bone with the implant. There was no distinguishable border between the two and he realized that he had stumbled onto something that could truly revolutionize surgeries related to bone. He later developed dental implants after extensive research and established Nobel Biocare as a manufacturer of dental implants. Constant research has helped in diversifying the type of implants available today, each one of which has specific uses. The two implants used in the case described below are the zygoma implants and conventional implants. Patient suffering from chronic gum disease and teeth problems The patient is a 58-year-old native of Hyderabad in Telangana. He has suffered from dental problems for a long time as he had not taken proper care of his oral hygiene and oral health. He has also had swollen and bleeding gums along with bad breath for many years now. Of late, he noticed that most of his teeth were mobile. This had made it difficult for him to eat and he had gradually reduced his food intake. His weight had gradually reduced because of this. Finally, he decided to seek a permanent solution for his problems. He decided to seek the advice of a dental specialist and stated that he had visited multiple dental hospitals and dental clinics elsewhere in search of a solution for his dental problems. They had recommended that he undergo total extraction followed by replacement with a removable complete denture, but he felt that it would be very inconvenient. Complete removable dentures can often become dislodged during speech and chewing if there is inadequate bony support. However artificial tooth manufacturing technology has come a long way from this dated treatment modality. One dentist he had visited had recommended dental implants as a solution for his problems. It was explained to the patient that long term benefits and the convenience factor was highest with dental implants. He then referred the patient to Balaji Dental and Craniofacial Hospital as it is renowned for dental implant surgery in Chennai. Our hospital is a specialty center for zygoma implant surgery in Chennai. Initial presentation at our hospital for consultation Dr SM Balaji, dental implant surgeon examined the patient. Dental implant placement is a treatment modality best performed by oral and maxillofacial surgeons. This revealed that the patient had generalized gum recession and bleeding along with bad breath. He also had a bridge in his upper jaw, which had become mobile. Most of the patient’s teeth were extremely mobile. He then ordered comprehensive imaging studies for evaluating the bone level in the patient’s jaws. This revealed severe generalized bone loss. Comprehensive treatment planning was done and explained to the patient in detail. He was made to understand the various surgical procedures that were involved in the extraction of teeth followed by placement of the implants. The patient was advised to undergo extraction of his remaining teeth followed by replacement with implants. Zygoma implants or zygomatic implants were advised for the patient as he lacked sufficient bone for conventional implants in the maxillary posterior region. The bone substitute with rh-BMP2 would to be used for sinus lift and also to augment the posterior maxillary ridge. This treatment plan was adopted as the patient was not ready for any major bone grafting procedures. He wished to undergo the whole procedure under local anesthesia if possible. The patient agreed to this treatment plan and gave his consent. About zygoma implants and rh-BMP2 bone replacement material Zygoma implants are different from conventional dental implants in that they anchor into the zygomatic bone rather than the maxilla. They may be used when maxillary bone quality or quantity is inadequate for the placement of regular dental implants. A bone substitute along with rh-BMP2 was used to help stimulate progenitor cells at the site into osteoblasts for formation of new bone. Rh-BMP2 is the result of biomedical engineering research that has many applications in oral and maxillofacial surgery. Patient undergoes total extraction followed by placement of implants The first step of treatment was removal of the mobile bridge. This was then followed by extraction of all the mandibular teeth. An incision was then made along the center of the mandibular alveolar ridge and a flap was elevated. This was followed by placement of the mandibular implants. The flap was then sutured close after placement of the implants. Extraction of the remaining maxillary teeth was performed next. A midcrestal incision was made and flap reflected. Bilateral sinus lift surgery was next performed through the lateral window technique. The Schneiderian membrane was then separated from the bone. The next step was placement of the zygoma implants bilaterally. Following this, a bone substitute mixed with rh-BMP2 was densely packed into the gap between the Schneiderian membrane and the bone. The entire maxillary ridge was also augmented using the bone substitute mix following which conventional Nobel Biocare dental implants were placed in the upper arch. Patient expresses his satisfaction at the results of the surgery Postoperative course was uneventful and the patient’s wounds healed well without any complications. The patient was given a removable partial denture following implant placement. Permanent fixed dentures will be placed in the patient’s mouth once complete osseointegration of the implant with the bone has been achieved in 3-4 months. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Facial Asymmetry Single Sitting Correction – Lefort I, BSSO and Sliding Genioplasty

[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=””][vc_column_text] Facial Asymmetry down the ages A certain proportion of the human population has always been affected by disabling facial asymmetry. This could be congenital as a result of developmental anomalies or birth injuries or acquired as a result of disease or trauma. Once of the most common causes of facial asymmetry is trauma. This trauma could either be accidental or inflicted during interpersonal conflicts. Human history is strewn with wars. Most major wars lead to landmark changes in the course of history. However, war has also extracted a horrific price from many soldiers. For example, trench warfare during World War I had an unnatural number of soldiers suffering serious facial injuries followed by lifelong facial deformities. A special unit was in operation in France during the war that crafted lifelike masks for soldiers with horrific facial deformities. Importance of facial symmetry No human face is truly symmetrical. Perfect symmetry is unnatural. There is an imperceptible degree of facial asymmetry present in each face. This small degree of facial asymmetry is what adds to the beauty of the face. When facial symmetry is 100%, it will look unnatural and unreal. However, this asymmetry should be imperceptible and not noticeable on first glance. When this facial asymmetry becomes too obvious, it becomes a social handicap leading to the person withdrawing from social contact. Surgery is needed to correct facial asymmetry. Surgical correction of facial asymmetry requires an artistic touch in addition to surgical skills. This is a requisite for good plastic surgery results. Surgical specialties that deal with facial asymmetry correction The services of a plastic surgeon or an oral and maxillofacial surgeon would be required for correction of facial asymmetry. They would be the equivalent of system administrator in the team that performs this surgery. Facial asymmetry commonly is a result of road traffic accidents. Horizontal osteotomy surgery is one of the treatments available for correction of mandibular asymmetry. Facial asymmetry correction surgery is performed by board certified surgeons who are well versed in their craft. There are various degrees of facial asymmetry, ranging from the very mild to extreme asymmetry. Functional difficulties caused by facial asymmetry Jaw discrepancies can lead to functional problems. These are corrected through orthognathic surgery. The degree of asymmetry determines the approach that is taken to correct it. Reconstructive surgery frequently uses bone grafting for correction of defects that cause facial asymmetry. Kashmiri man with facial asymmetry referred to our hospital The patient is a 26-year-old Kashmiri man with facial asymmetry. He has a distant history of trauma to the chin. Wishing to have his facial asymmetry corrected, he visited a local oral surgeon who explained to him that he needed reduction of the right side of the mandible and maxilla to correct his asymmetry. It was further explained to him that facial asymmetry correction surgery in India was performed only at a few specialty surgical centers. He was then referred to Balaji Dental and Craniofacial Hospital for surgical management of his facial asymmetry. Treatment planning explained in detail to the patient Dr SM Balaji, facial asymmetry correction surgeon, examined the patient and ordered 3D CT scan and other imaging studies. This revealed that the patient had a hyperplastic right mandibular condyle. As a result, the right side of his mandible was bigger than the left and he has a downward left to right occlusal cant. Using facial biometrics to study the skull, he explained the treatment planning in detail to the patient and the patient consented to surgery. Le Fort I osteotomy correction of maxillary occlusal cant Under general anesthesia, a maxillary vestibular incision was made in the sulcus and a Le Fort I osteotomy was performed. The right maxilla was disjointed and a 10-12 mm segment of bone was removed from the region. This resulted in correction of the maxillary occlusal cant and the maxilla was stabilized and fixed with titanium plates and screws. This resulted in an open bite on the corrected side. This will be corrected by the bilateral sagittal split osteotomy (BSSO) of the mandible. Bilateral sagittal split osteotomy of the mandible for occlusal cant correction Following this, a right sided buccal vestibular incision was made in the mandible for the bilateral sagittal split osteotomy. This was repeated on the left side. BSSO was performed with an uplift of 10-12 mm of mandibular bone on the right side. This resulted in correction of the occlusal cant with establishment of perfect occlusion. The mandible was then stabilized and fixed with titanium plates and screws. Sliding genioplasty for restoration of full facial symmetry However, it was noticed that the chin was still skewed after the jaw surgeries. So attention was next turned towards correction of the chin. A reciprocating saw was used to perform an osteotomy and the chin was repositioned with a sliding genioplasty and fixed with titanium plates and screws. This resulted in complete correction of the patient’s facial asymmetry. All incisions were then closed with sutures and the patient taken to the recovery room in stable condition. The patient expressed his full satisfaction with the results of surgery before final discharge from the hospital.[/vc_column_text][vc_video link=”https://youtu.be/2Z2WDUstMLw”][/vc_column][/vc_row][/vc_section]

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Facial Asymmetry Correction Surgery – Simultaneous Mandibular and Maxillary Distraction

[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=”What is hemifacial microsomia” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Hemifacial microsomia is a congenital disorder, which mostly affects the development of the face. A congenital disorder is a disease condition that exists at the time of birth. The lower half of the face including the lower jaw and the ears are affected the most. There is a small jaw and rudimentary external ears. At times, it is so severe that the external ears are just skin tags. Ear reconstruction is best performed after 10 years of age. It usually affects only one side of the face and is rarely bilateral. The rudimentary ears need ear reconstruction surgery with cartilaginous grafts from the ribs.[/vc_column_text][vu_heading style=”2″ heading=”Rudimentary external ear or microtia correction surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Microtia surgery is performed by only a few experienced surgeons. It is a very difficult surgery that requires years of experience to master. It is a three step surgery. During the first surgery, the cartilaginous rib grafts are crafted and shaped according to a template that is obtained from biometric study of the patient’s face. This is a procedure that requires a great deal of artistic skill since the graft has to be crafted to be symmetrical to the patient’s normal ear.[/vc_column_text][vu_heading style=”2″ heading=”The three steps of successful ear reconstruction surgery or cosmetic ear surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This graft is first placed in a skin pocket created in the region of the patient’s external ear. This is allowed to mature. The second and the third stages of the procedure involve lifting up the cartilaginous graft using skin flaps so that it perfectly mimics the patient’s normal ear in structure. Children who undergo this procedure are ecstatic at seeing the results of the procedure as they have always felt self conscious, fearing comments from other children.[/vc_column_text][vu_heading style=”2″ heading=”Effects of hemifacial microsomia on the quality of life of the patients” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Disability from hemifacial microsomia is at many levels. The facial asymmetry also results in the patient withdrawing into a shell, shying away from all social contact. Absence of an external auditory canal is one of the symptoms of hemifacial microsomia. It is also a feature of craniofacial microsomia. Hearing loss is a common presentation in this presentation. Bony conduction of hearing is however present in a majority of cases. The use of cochlear implants greatly enhances the patient’s ability to hear.[/vc_column_text][vu_heading style=”2″ heading=”Static or dynamic smile recreation surgery through fascia lata graft” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Patients suffering from hemifacial microsomia also have an asymmetrical mouth. A beautiful smile is the ornament of a vibrant personality. The asymmetrical mouth makes them very self conscious and they tend to avoid eye contact with other people. This can be rectified through judicious performance of facial reanimation surgery. A strip of fascia lata graft is first harvested from the thigh.[/vc_column_text][vu_heading style=”2″ heading=”Transformation in the life of patients after facial reanimation surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]This strip of fascia lata is used as a graft to connect the labial commissure of the affected side of the mouth to a dynamic muscle, which when activated results in a beautiful smile. The fascia lata graft is tunneled from the muscle to the angle of the mouth and anchored in place using sutures. This is a life changing surgery and patients undergoing this have a transformed personality due to regaining their ability to smile, which enables them to connect with others.[/vc_column_text][vu_heading style=”2″ heading=”Jaw reconstruction surgery for correction of asymmetrical mandible” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Jaw correction is achieved through mandibular distraction osteogenesis by the use of distraction devices on the affected side. Plastic reconstructive surgery (plast reconstr surg) is the surgery of choice for correction of the facial asymmetry that results from hemifacial microsomia. Correction of soft tissue defects is through the use of fat grafts. Le Fort I osteotomy is performed when there is involvement of the maxilla in craniofacial microsomia. Use of bone graft in deficient bone segments is used to correct any residual facial asymmetry after completion of the osteotomy.[/vc_column_text][vu_heading style=”2″ heading=”Patient with long standing facial asymmetry due to hemifacial microsomia” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient is a young man from Solapur, Maharashtra. He had begun noticing a facial asymmetry a few years ago that had developed gradually. He had also progressively developed difficulty with chewing and speech. This problem was slowly turning debilitating and his quality of life had significantly declined. He had habitually started tilting his head to the left side to conceal his facial asymmetry from other people. This had resulted in severe spasms of his neck muscles. The spasms were very painful and had begun to affect his sleeping cycle. This chronic lack of sleep had begun to affect all walks of his life including his work life.[/vc_column_text][vu_heading style=”2″ heading=”Patient and parents seek medical help to help the patient” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]He and his parents approached a local oral surgeon for diagnosis and treatment due to the severe neck pain. It was explained to them that the patient had a high degree of facial asymmetry with a skewed occlusal cant. He diagnosed the patient as having hemifacial microsomia. The patient required facial asymmetry correction surgery. It was explained to them that facial asymmetry surgery in India was performed only in a few specialty centers. The patient and his parents were then referred by him to Balaji Dental and Craniofacial Hospital in Chennai, India.[/vc_column_text][vu_heading style=”2″ heading=”Treatment planning explained and consent obtained for distraction osteogenesis” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji examined the patient and ordered detailed imaging studies including a 3D CT scan. Biometrics were then obtained, which revealed a 10 cm shortening of the ramus on the left side when compared to the right. It was decided to proceed with simultaneous maxillary and mandibular distraction for the patient. The treatment planning was explained in detail to the patient and his...

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