Blog - Balaji Dental and Craniofacial Hospital

February 28th, 2019 04:50 pm February 28, 2019

Jaw reconstruction surgery with rib graft followed by dental implant surgery on reconstructed jaw

[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=”Jaw reconstruction surgery down the ages” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Mankind has always been prone to violence with a history strewn with small battles and major wars. Back in the olden days, fighting was invariably close contact before the invention of weapons whose destructive capabilities could wipe out entire sections of an army with one single shot. This close quarter fighting with swords and knives invariably resulted in horrific hard and soft tissue damage. Even though the soldiers wore protective armor, this was rarely adequate to avoid injuries. Jaw fractures were common and debilitating for those surviving them.[/vc_column_text][vu_heading style=”2″ heading=”Initial steps towards formulating a protocol for jaw reconstruction” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dental specialists and surgeons tried their best to restore enough esthetics and function for the patient to integrate back into society after the wars, but this was prevented by serious infections caused by poor oral hygiene, which left the survivors with severely disfigured faces and bodies. Using artificial teeth through the utilization of removable dentures to bring a semblance of normalcy to shattered jaws proved to be grossly inadequate. Jaw reconstruction proved to be a task that was well beyond the capabilities of mankind at that point in time. Cosmetic surgery and artificial tooth fabrication technology was still in its infancy with poor esthetics.[/vc_column_text][vu_heading style=”2″ heading=”Development of jaw reconstruction surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Jaw reconstruction surgery is a relatively modern surgical procedure. It made its first appearance in the most rudimentary of forms in the year 1846 when Dr Simon Hullihen performed the first orthognathic surgery involving mandibular osteotomy with setback for a patient. An improvement in the understanding of the growth and development of the jaws including the genesis of the dental lamina, rete ridges and epithelial lining along with the development of general and local anesthesia led to improvement in jaw surgery techniques.[/vc_column_text][vu_heading style=”2″ heading=”Patient with pain and swelling in her jaws presents to a local dentist” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient is a young woman who presented with a slight swelling and pain in the premolar region of the left mandible. There was also displacement of the teeth in that region. She and her parents had presented to an oral surgeon in her hometown who had obtained radiographs of the region.[/vc_column_text][vu_heading style=”2″ heading=”Two failed cyst enucleation surgeries in her hometown” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]He diagnosed the patient to have a cystic lesion in that region. The patient was informed that she would require enucleation of the cyst followed by reconstruction of the jaw at a later date. She and her parents consented to surgery, but unfortunately, the cyst recurred a few months after surgery. She had approached the same surgeon again who had performed another enucleation, which again was followed by recurrence of the cyst a few months later.[/vc_column_text][vu_heading style=”2″ heading=”Referral to our hospital for single sitting enucleation and jaw reconstruction surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Feeling very frustrated, she and her parents had sought a second opinion from a plastic surgeon in their home town who had explained to the parents and the patient that a single sitting cyst enucleation followed by jaw reconstruction surgery in India was performed in only a few specialty centers. He then referred the patient to Balaji Dental and Craniofacial Hospital in Chennai, India for surgical management of her cystic lesion.[/vc_column_text][vu_heading style=”2″ heading=”Diagnosis and treatment planning presented to the patient” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient was examined by Dr SM Balaji, jaw reconstruction surgeon who then proceeded to order imaging studies for the patient including a 3D CT scan and also a biopsy, which revealed an odontogenic keratocyst. Odontogenic keratocysts (OKCS) always have to be removed completely in order to prevent relapse like the patient had experienced earlier. This is one of the common odontogenic tumors. He explained the treatment planning including the bone grafting with rib grafts to the patient and her parents who consented to surgery. The implant surgery would give perfect lifelike replacements for the natural teeth. Any impacted wisdom teeth if present are extracted during the time of this surgery.[/vc_column_text][vu_heading style=”2″ heading=”Cyst removal followed by jaw reconstruction surgery” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under general anesthesia, two rib grafts were harvested from the patient. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers. Attention was then turned to the cyst enucleation and jaw reconstruction portion of the surgery. The gingiva overlying the region of the cyst was retracted to expose the cyst. Contents of the cystic cavity were completely enucleated. The teeth overlying the cyst were also extracted and removed. The two rib grafts were then crafted and shaped to fit snugly into the bony defect left behind by the cyst. These were then fixed with screws and the flap closed with sutures.[/vc_column_text][vu_heading style=”2″ heading=”Dental implant surgery to complete full oral rehabilitation” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient returned after three months for dental implant surgery. Radiographic studies demonstrated that the grafts had fused with the jaw bone and there was full correction of the bony defect from the cyst removal surgery. A dentoalveolar flap was raised and the screws used to fix the grafts were removed. This was followed by placement of four dental implants in the region. The flaps were then closed with sutures. The patient will return in six months after the healing process is complete and there is full osseointegration of the implants with the jaw bone. Crowns will be placed over the implants at that time to complete total oral rehabilitation for the patient.[/vc_column_text][vu_heading style=”2″ heading=”Surgery Video” subheading=”” alignment=”left” custom_colors=”” class=””][vc_video link=”https://www.youtube.com/embed/vGgx10VUqEA”][/vc_column][/vc_row][/vc_section]

February 26th, 2019 12:24 pm February 26, 2019

smbalajiSurgery 331

Facial Asymmetry Correction Surgery Simultaneous Maxillary & mandibular Distraction

February 21st, 2019 09:16 pm February 21, 2019

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Jaw reconstruction surgery with bone graft after removal of odontogenic keratocyst

Genesis and characteristics of an odontogenic keratocyst A cyst is essentially a sac of membranous tissue that can occur anywhere in the body. They normally contain fluid, but other substances can also be found inside them on occasion. Cysts are benign and not cancerous growth. There are many kinds of cysts. They include epidermoid cyst, sebaceous cyst, pilonidal cyst, ovarian cyst, chalazion of the eyes, popliteal cyst and pilar cyst amongst others. Varieties of common cystic lesions Treatment of cysts includes excision and careful enucleation of the cystic lesion including the membranous lining of the cyst. Any remnants left behind during enucleation can lead to recurrence of the cyst. Care has to thus be taken to ensure complete removal of the contents of the cystic cavity. Some of the more common cysts include the sebaceous cyst, the chalazion, and the epidermoid cyst. Cysts can turn painful when they occur in a confined space or get infected. Epidermoid cysts are slow growing cysts that are the result of keratin buildup under the skin. They can get infected easily as they are very close to the surface of the skin. Sebaceous cysts occur when sebum glands get clogged leading to a buildup of sebum. This too can get infected easily. Surgical excision is the treatment of choice for both these cysts. A pilonidal cyst occurs at a hair follicle and is said to occur due to a combination of hormonal changes, friction or prolonged pressure to that region. It can be quite painful and there is a foul smelling discharge from the cyst. A hair follicle is also present in association with the cyst. Treatment is curettage and enucleation along with removal of the associated hair follicle. Etiology and pathogenesis of odontogenic keratocyst An odontogenic keratocyst is a very rare benign developmental cyst that is very aggressive. It results in extensive destruction of the bone. It is most commonly seen in the posterior mandibular region in the third decade of life. The PTCH1 gene, which leads to the occurrence of odontogenic keratocyst has also been linked to the occurrence of ovarian cysts and ovarian cancer. Differential diagnoses for odontogenic keratocysts can include epidermoid cysts though these are completely different in their origin. Recommended treatment protocol for odontogenic keratocysts Treatment of the odontogenic keratocyst involves meticulous resection to completely remove the lesion followed by reconstruction of the jaw with bone grafting. Implant surgery for the placement of dental implants is performed after full bony consolidation of the bone grafts to complete full oral rehabilitation for the patient. This is the treatment protocol that is recommended by the American Association of Oral and Maxillofacial Surgeons. The patients thus properly cared for can go on to lead a completely normal life. Use of dental implants for oral rehabilitation from destructive jaw lesions The advent of dental implant treatment has enabled complete rehabilitation patients with odontogenic keratocyst. Implants enable replacing missing teeth. Success rates are extremely high for patients rehabilitated with dental implants. This is because dental implants mimic tooth roots and are able to bear occlusal loads that are borne by natural teeth. Before dental implant treatment became a part of routine surgical protocol, postsurgical dental rehabilitation was through the use of removable dentures. This was highly unsatisfactory for the patient. The patient faced a lot of difficulty with both chewing and speech. Dental implants have enabled the complete rehabilitation of both the upper and lower jaws. Proper maintenance of dental implants aided by following instructions of the implant surgeon meticulously is essential for the success of dental implant treatment. Patient develops pain and swelling in the left posterior mandibular region The patient is an 18-year-old female who had slowly developed a soft tissue swelling of the left posterior mandible with pain for the last six months. She had consulted a local dentist who noticed that the patient’s left third molar was missing from the oral cavity. Suspecting the swelling to be a dentigerous cyst, he had referred the patient to our hospital for management. Our hospital is a renowned center for jaw reconstruction surgery. Implants will need to be placed to complete oral rehabilitation after jaw reconstruction surgery. Examination of the patient at our hospital with subsequent investigations The patient presented at our hospital for management of the pain and swelling in her left posterior mandibular region. Dr SM Balaji, an oral and maxillofacial surgeon and jaw reconstruction surgeon in Chennai, examined the patient and ordered imaging studies and a biopsy of the lesion. The biopsy results returned as odontogenic keratocyst. Imaging studies revealed a radiolucent lesion in relation to the left mandibular molars and a horizontally impacted third molar. Treatment planning for the management of the odontogenic keratocyst was explained to the patient in detail. She was advised to undergo cyst removal surgery and was in total agreement with surgical management of the lesion. Bone graft harvested from the patient for jaw reconstruction Under general anesthesia, rib grafts were first harvested from the patient. The rib grafts will be used to reconstruct the jaw after resection of the odontogenic keratocyst. A Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. Following this, the incision was then closed in layers with sutures. Resection of the odontogenic keratocyst from the left posterior mandible. A mucogingivoperiosteal flap was raised in the left posterior mandibular region. This exposed the area of the odontogenic keratocyst. The cystic lesion was exposed and then completely resected. Great care was taken to ensure that there were no cystic remnants left behind in the bony cavity. The rib grafts were then carefully shaped to fit into the bony defect left behind by the lesion. Titanium screws were used to fix the rib grafts into the bony defect in the jaw to reconstruct the jaw. Once adequate jaw reconstruction had been achieved with the rib grafts, the flap was then closed with sutures. The healing process along with bone remodeling of the grafts to merge...

February 17th, 2019 07:26 pm February 17, 2019

smbalajiSurgery 331

Metopic synostosis – Trigonocephaly – Anterior Calvarial Reconstruction with Fronto Supraorbital Remodeling

The occurrence of craniofacial abnormalities in infants A small percentage of infants are born with craniofacial anomalies. The frontal, parietal, sphenoid, occipital and temporal bones comprise the bones of the skull. The joint between these bones are called sutures. Infants born with trigonocephaly have a noticeable ridge running down the middle of the forehead. The old terminology for this defect was metopic craniosynostosis. These birth defects are corrected by a surgery comprising of a team of neurosurgeons, plastic surgeons and craniofacial surgeons. This also comes under the purview of plastic surgery as there is esthetic improvement in the shape of the baby’s skull. Cleft lip surgery is an example of plastic surgery where there is functional as well as esthetic improvement through surgical intervention. Advent of the CT scan has enabled the development of such complicated surgeries to have a high degree of success. Young child with metopic synostosis and trigonocephaly The patient is a 6-month-old boy who was born in Punjab, which is the agricultural heartland of India. His parents noticed that his head was abnormally triangular in shape when viewed from above. There was also a prominent bony ridge on his forehead. Alarmed about this, they approached a local neurosurgeon. Suspecting that the patient had premature fusion of the metopic suture, the neurosurgeon obtained x-rays and diagnosed metopic synostosis with trigonocephaly. Referral to our hospital from World Craniofacial Foundation He got in touch with the World Craniofacial Foundation (WCF), which is an organization that helps with complete surgical rehabilitation of children born with prematurely fused cranial bones and other craniofacial deformities. Dr Kenneth E Salyer, Founder and director of WCF then referred the patient for surgery to Balaji Dental and Craniofacial Hospital (BDCH) in Chennai. Having identified BDCH as a center of excellence for craniofacial surgery in India, WCF had made the Balaji Craniofacial Foundation its Asian affiliate partner for referring such cases to our hospital. Confirmation of diagnosis at our hospital Dr SM Balaji, craniofacial surgeon, examined the patient and ordered 3D CT and other comprehensive imaging studies for the patient. These confirmed that the patient had metopic synostosis with trigonocephaly. This is a condition that arises from the premature fusion of the metopic suture of the skull. This results in the triangular shape to the skull. A 3D stereolithographic model of the skull was obtained. In consultation with the neurosurgical team, a mock surgery was performed on this skull. Meticulous treatment planning was done and explained to the parents of the boy. They gave their consent and the child was scheduled for surgery. Surgical correction of craniofacial deformity Under general anesthesia and with the entire neurosurgical team in attendance, marking were made on the scalp and a bicoronal flap was raised to expose the trigonocephaly deformity on the frontal bone. Following this, bur holes were made on the frontal bone and a frontal bone osteotomy was performed using the craniotome. The frontal bone was then gently lifted out. Fixation with sonic welding of the resected bones Next, beginning at the pterion, a bone cut was made at the frontozygomatic suture and extended through the roof of the orbit to the frontonasal suture. This was then extended to the contralateral side. This resulted in complete detachment of the supraorbital bar from the skull. The metopic ridge on this segment was then trimmed. This was then advanced anteriorly by around 3-5 mm and fixed using sonic welding. Advantages of using sonic welding over conventional titanium screws Sonic welding consists of a polymer implant, which is picked up by the hand piece tip and inserted into the predrilled hole in the bone. When an ultrasonic sound wave is generated at the tip of the hand piece, the resultant vibration causes friction between the bone and the implant. This melts the polymer and makes it flow into the surrounding trabeculae of the bone. The polymer hardens once the hand piece is removed. This stabilizes the segments of the bone and holds it in place. The polymer slowly dissolves by the time bone healing is completed, thus making another surgery for removal of the implants unnecessary. The metopic ridge on the frontal bone was also trimmed. Barrel stave osteotomy cuts were then performed on the frontal bone in order to create space for the growing brain. Following this, the frontal bone was placed back in position and fixed with sonic welding and dural hitch sutures. The bicoronal flap was then brought back into position and closed with staples. The patient recovered well from general anesthesia and was taken to the recovery room in stable condition. Skull anatomy was observed to be normal and the parents of the baby were extremely satisfied at the results of the surgery. Complete recovery during the postoperative period On the fourth postoperative day, the drains from the surgical site were removed and the patient was back to baseline behavior. The staples were removed on the 12th postoperative day and there was good healing of the bicoronal flap. The patient was later feeding normally in the ward and was observed to be playing with his elder sibling. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

February 14th, 2019 09:29 pm February 14, 2019

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Lip Scar Revision and Removal of notching with Lip bulk increasing Surgery

Etiology of cleft lip and palate deformity formation Cleft lip and palate deformity is the second most common congenital deformity in the world. The first is Down’s syndrome. Cleft lip and palate formation can be genetic, environmental or idiopathic. There is a higher chance of a baby with cleft being born to parents with cleft lip or palate. However, the gene responsible for cleft formation is yet to be identified. Environmental factors include smoking, exposure to excess second hand smoke, alcohol intake and usage of certain illicit drugs. A clear link has been demonstrated between these factors and increased risk for cleft lip and palate formation. Cleft lip correction is performed at 3 months of age and palate correction is undertaken at around 10-12 months of age. The lip repair is an intricate surgery performed by the cleft lip surgeon. The upper lip consists of three segments, which fuses in utero to form the upper lip. A split lip occurs when fusion of these segments does not happen. The lip tissues consist of the epithelium and underlying dermis muscles. Cleft palate surgery is performed when there is a hole connecting the oral cavity with the nasal cavity in the roof of the mouth. A lip correction surgeon has to perfectly align these three elements of the upper lip. Perfect fusion results in minimal scar formation, which slowly fades away with time. When this alignment is less than ideal, it leads to thickened scar formation and muscle contracture of the lips. This causes a lack of full lip seal and poor esthetics. Scar revision surgery is performed to remove any unsightly hypertrophic scar tissue. This plastic surgery is performed keeping in mind the tissue planes of the lip. History of cleft lip surgery in the olden days There was a period in human history where babies born with a cleft were considered to be evil and were abandoned and left to die. This was brought about by mainly superstition and ignorance. Such practices were the norm for many babies born with deformities during that period. It was only after science began taking roots within human society that superstition and ignorance were overcome by humans and people began looking for ways to alleviate human suffering. Ancient China boasted of a remarkable degree of scientific knowledge compared to most other parts of the world. The world’s first cleft lip repair was performed in China even before the advent of Christianity in the world. Greek and Egyptian medicine was also remarkably advanced for the times, but records from that period of human history have unfortunately been lost. Cleft lip closure was performed successfully essentially because it involved only the soft tissue. Any involvement of the bone automatically rendered the process very difficult and prone to failure. It was because of this that the first successful cleft palate closure was accomplished only sometime during the eighteenth century. Patient with a history of cleft lip and palate surgery referred to our hospital The patient is a young man of 22 years of age who had undergone lip and palate repair as an infant. He also has a history of undergoing pharyngoplasty surgery and repair of the soft palate. He now feels that his upper lip is too long and there is insufficient show of upper teeth during smiling. This had left him feeling despondent and withdrawn. The patient also felt that his upper lip lacked adequate fullness. His parents had presented to a local plastic surgeon in their hometown who felt that he needed cosmetic lip surgery. He then referred them to our hospital for surgical correction of his complaints. Initial examination with treatment planning explained to the patient Dr SM Balaji, cosmetic lip surgeon with over 27 years of experience in cleft lip and cleft palate repairs, examined the patient and ordered biometric studies. This revealed that the patient had a long upper lip without adequate fullness. The surrounding skin tone and texture was also noted. Patient expressed his desire for fuller lips. This called for lip augmentation or lip enhancement surgery. He explained the treatment plan to the patient and his parents, which involved obtaining a fascia lata graft from the thigh region followed by a bullhorn incision to the upper lip at the base of the nose to shorten the upper lip. It was felt that artificial lip implants would not give optimal results in this case and there could also be adverse side effects. The patient and his parents were in agreement with the treatment plan and consented to surgery. It was ascertained that the patient had no allergic reaction to any of the medications that would be used during and after surgery. The patient would be prescribed hyaluronic acid after surgery to improve healing of the wounds. Surgical correction with bullhorn incision and fascia lata graft Under general anesthesia, the patient was prepped and draped for lip scar revision surgery. Markings for the bullhorn incision were made under the nostrils and extended downwards to include the scar from the previous cleft lip surgery. Incisions were then made along the markings and the hypertrophic tissue excised. The fascia lata graft was then inserted into the upper lip to increase the fullness of the lip. Upper lip was then sutured back in a slightly superior position. This resulted in a lip length that was proportionate to the rest of the face. Healing proceeded uneventfully with minimal residual scar formation. The patient and his parents expressed complete satisfaction at the results of the surgery before final discharge from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

February 11th, 2019 07:09 pm February 11, 2019

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Cleft Rhinoplasty – Nose Correction Surgery

Different nasal forms and the human face The nose is the most prominent feature in the human face. Evolution down the ages had resulted in a wide variation to human facial features. This ranges from the color of the skin to the shape of the nose or the shape of the chin being different although the DNA is the same. Environmental factors, diet and a few other factors had influenced this. For example, people from very cold places that received very little sunlight developed light skin and aquiline noses. This served an evolutionary function as less body heat was lost through lighter skin and passage of cold air breathed in through long noses resulted in adequate humidification and warming up of the air as it passed into the trachea. Likewise, people in hotter regions of the earth developed darker skin and noses with wide open nostrils. This enabled easier cooling down of the body as well as cooling down of the air as it passed in through the broader nostrils. Functional versus cosmetic rhinoplasty Functional rhinoplasty is performed when the patient is having problems with breathing or if the deformity of the nose is to a degree that it is affecting their normal functioning in society. This can range from anything from a deviated nasal septum to reconstruction of the nose affected by a cleft lip deformity. A functional rhinoplasty correction also invariably results in improvement in the cosmetic appearance of the nose. Cosmetic rhinoplasty is performed when the patient has no functional difficulties, but is simply dissatisfied with the appearance of the nose. This is a completely elective procedure and is performed by either plastic surgeons or oral and maxillofacial surgeons. Surgeons from both these specialties undergo years of extensive training in this procedure. Young woman with a previous history of cleft lip and palate repair The patient is a young woman from Jharkhand who had undergone repair of her cleft lip and palate as an infant. She had however always had a nasal deformity with a flattened bridge of the nose and a collapsed columella. She had also had nasal breathing problems and snoring during sleep. She desired to undergo cosmetic surgery by a facial plastic surgeon to correct this. This variety of plastic surgery is also performed by oral and maxillofacial surgeons. Cleft rhinoplasty elsewhere with unsatisfactory results from the surgery She underwent a rhinoplasty elsewhere two years ago, but was very unhappy with the results of the previous rhinoplasty. She felt that the bone grafting to augment the bridge of her nose was too bulky and her breathing difficulties had worsened. Bone grafting had also been performed to a bony deficiency in the left anterior alveolar region. Patient referred to our hospital for revision rhinoplasty surgery She and her parents presented to a local plastic surgeon who advised revision cleft rhinoplasty surgery to correct her problem. He referred them to our hospital as this required a redo rhinoplasty surgery. This redo rhinoplasty required advanced techniques as the primary rhinoplasty procedure had been improperly performed. The graft placed in the previous surgery had to be removed followed by placement of a newly harvested bone graft. This rhinoplasty procedure is best performed by an experienced rhinoplasty surgeon. It is only board certified oral and maxillofacial surgeons who perform this surgery in developed countries like the US, UK, Germany and Japan. The nasal bones could have been deformed by the previous surgery. Formation of excess scar tissue could cause this sort of deformity. The nose had to be brought into perfect alignment with the facial features. Initial examination and treatment planning of the patient They presented for consultation with Dr SM Balaji, rhinoplasty specialist, who examined the patient and ordered imaging studies. This revealed that the patient had a collapsed columella and the graft at the augmented bridge of the nose had shifted. Merits of an open rhinoplasty versus closed rhinoplasty were considered for the patient. He explained to the patient and the parents that he needed to harvest new bone grafts to correct this deformity. The patient and her parents were in agreement with the treatment plan and consented to surgery. Harvesting costochondral rib grafts for the surgery Under general anesthesia, an incision was made through the old scar from the site of the previous bone graft. Two costochondral rib grafts were harvested and a Valsalva maneuver was performed to ensure patency of the thoracic cavity. The incision was closed in layers after confirming this. Cleft rhinoplasty with placement of columellar strut graft Attention was next turned to the revision cleft rhinoplasty nose surgery. A vestibular incision was made in the anterior maxilla and the bone graft used to augment the bony depression in the anterior maxilla was exposed. The titanium screw used to fix the screw was removed and the region was further augmented with a rib graft shaped to fill the bony depression in the region. Attention was next turned to the revision rhinoplasty portion of the procedure. The costochondral grafts were contoured to the correct shape. The previously placed rib graft was removed. An intranasal incision was then made and a graft was tunneled in to give perfect form to the bridge of the nose. The second costochondral rib graft was then used as a strut graft to raise up the collapsed columella. This was tunneled into the columella through an intraoral approach and secured in place with sutures. This gave perfect form and symmetry to the nose. The vestibular incision was then closed with sutures and the patient extubated from general anesthesia. Patient and her parents expressed complete satisfaction at the results from the surgery before final discharge from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

February 8th, 2019 06:18 pm February 8, 2019

smbalajiEvents 87

Research in Salivary Diagnostics informal symposium held at Balaji Dental and Craniofacial Hospital

[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] Balaji Dental and Craniofacial Hospital hosts Research in Salivary Diagnostics symposium Balaji Dental and Craniofacial Hospital was the venue for the introductory presentation on “Research in Salivary Diagnostics,” held on February 2, 2019. This informal symposium was organized by the director, Dr SM Balaji, who has always stressed on the importance of meaningful research in dentistry and its allied branches. Dr Preetha Balaji, Consultant Maxillofacial Surgeon, was also present at the gathering. An introduction into Salivary Diagnostics Salivary Diagnostics is a very advanced and newly introduced concept. It has been shown to have greater acceptance amongst patients because of its noninvasive nature and amongst doctors and researchers for its greater sensitivity and specificity when compared to existing modalities. The use of salivary diagnostics and research has thus far been limited to a few diseases and conditions. Deans and principals invited for dissemination of information about Salivary Diagnostics This meeting was organized as a means to introduce this to Indian Dentists and popularize the concept through the deans and vice principals of Chennai based dental colleges and hospitals. Further programs have been planned down the line to further disseminate information regarding the scope of including more diseases that can be diagnosed using this modality. Eminent scientific researchers invited as principal speakers for symposium The invited speakers were[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/4″][vc_single_image image=”5499″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”3/4″][vc_column_text]Dr. Paul Slowey, USA, who spoke on “Standardized Devices for Salivary Diagnostics”. Dr. Paul Slowey is the CEO of the Oasis Diagnostics Corporation, USA. His presentation concentrated on addressing a growing need for non-invasive saliva based technology for rapid testing, sample collection, and molecular diagnostics [DNA, RNA and proteins] to alleviate human suffering and usher in a new era of improved health. He spoke at length about the success of his concepts and possible avenues for collaborating with Indian dental researchers.[/vc_column_text][/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=”1/4″][vc_single_image image=”5501″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”3/4″][vc_column_text]Dr Benji Pretorius, South Africa, spoke on “Rapid Diagnostic using Saliva instead of blood”. Dr. Benji Pretorius is the founder of ERADA Technology Alliance Ltd (ERADA). This is a unique collaborative effort between the South African governmental agencies, Johns Hopkins University and Dinglasan Malaria Laboratory in Florida, US. His work ultimately aims to eradicate malaria from the world and he has had stupendous success in using saliva as an early diagnostic tool for malaria in South Africa. He described in detail the concepts and success of the Saliva-based Malaria Asymptomatic & Asexual Rapid Test – a non-invasive diagnostic for the detection of sexual stage Plasmodium falciparum gametocytes even at a low concentration.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row] Later, the Deans and Vice Principals of Chennai based Dental Colleges interacted over dinner with Dr. Paul Slowey and Dr. Benji Pretorius.

February 5th, 2019 01:51 pm February 5, 2019

smbalajiSurgery 331

Simultaneous Unilateral Cleft Lip and Palate Repair

Baby boy from Assam This baby boy from Assam was born with a cleft. He is about one year of age. The incidence of cleft lip and palate in newborns is comparatively higher in Assam. The baby had a split upper lip. He also had a hole in the roof of his mouth which affected his feeding. An ultrasound test during development in the womb revealed that the developing baby had a cleft. There is a history of clefts running through the family. Even though the parents were aware of the right time to perform the surgery, they were hesitant and brought the baby only at about one year of age. They, however, requested for simultaneous cleft lip and palate correction. Unilateral cleft lip and palate Unilateral cleft lip is a congenital split in the upper lip on one side. It is often associated with cleft palate. The cleft palate refers to a hole in the roof of the mouth. It usually involves the soft palate and hard palate. Babies with cleft lip and palate have difficulty in feeding. They have nasal regurgitation. Cleft babies may develop various problems as they continue to grow. They develop dental problems which require corrective treatments. The dental problems may require surgical and non-surgical intervention. They also have an increased risk of middle ear infections which may lead to hearing problems. Babies born with clefts may have speech problems. Thereby requiring a speech therapist opinion. Types of clefting There are various types of clefting which may involve oral and nasal cavities. They are Incomplete Unilateral and Bilateral Cleft lip and palate surgery in India The parents were very depressed with their baby’s condition. They were very concerned about her future. They were searching through the internet for the best cleft lip surgeon in India. They were referred to our hospital by a local physician. Dr.S.M.Balaji one of the leading cleft lip and palate surgeon in India examined the patient. He agreed to correct the cleft lip and palate simultaneously. The oral and nasal cavities had to be closed also. Cleft palate repair Cleft palate repair was to be done first. The abnormal palatal musculature was to be corrected during the surgery. The cleft palate repair was done using Veau Wardill Kilner’s technique. Primary cleft lip repair Corrective lip repair was also of utmost importance. Cleft lip and palate surgeon Dr. S.M. Balaji also performed cleft palate repair at one year of age. Unilateral cleft lip repair is done using Modified Millard’s technique. The upper lip musculature was also corrected during the surgery. Surgery outcome: The result of the surgery was as expected. He looked normal unlike any other child of his age with minimal to no scar. The parents were pleased with the outcome of the surgery. Future surgical corrections: Bone grafting is to be done at 3 and a half to 4 months of age thereby promoting bone growth. Speech correction / Pharyngoplasty may be necessary at 3-4 years of age. Further surgical corrections will be carried out at later date.

February 4th, 2019 10:32 am February 4, 2019

smbalajiEvents 87

Dr Preetha Balaji receives the Young Maxillofacial Surgeon Award

February 1st, 2019 10:09 pm February 1, 2019

smbalajiSurgery 331

Cosmetic eye surgery with lateral canthopexy for antimongoloid slant correction

Presentation of antimongoloid slant and its occurrence A downward slant from the medial canthus to the lateral canthus of the eye is termed as an antimongoloid slant. It is the direct opposite of the mongoloid slant where the downward slant is from the lateral to the medial canthus of the eye. It can be idiopathic in nature or can occur as a part of a syndromic presentation including as a part of Treacher-Collins syndrome and Franceschetti syndrome. An eyelid surgery is performed to correct this. Characteristics of the antimongoloid slant in eyes Patients who have an antimongoloid slant to their eyes have no functional deficits to their eyes. It is only when patients are uncomfortable with the esthetic appearance of their eyes do they opt for surgical correction of this condition. Subtle body language cues that can alter the very meaning of spoken words Human communication can be divided into two components. One is verbal and the other is nonverbal cues. You would notice that when a person talks to another, they use their mouth to articulate the words, but special emphasis is laid to nonverbal communication through the use of hand movements and eye movements. Subtle differences brought about by nonverbal cues can change the entire tone of the communication even if the words remain unchanged. Rationale behind opting for cosmetic eye surgery in the modern world When one feels uncomfortable with the appearance of their eyes, this makes them feel very self conscious. This immediately leads to a sense of awkwardness that impedes effective communication. Communication is the tool through which we make a mark on the world around us. When this is affected by any factor, our very growth and integration into the community around us, whether at home or at the workplace is affected. Care has to be taken by the surgeon to ensure that the functional integrity of the eyes is not compromised by this surgery. This is a completely elective eye surgery on the patient’s part to undergo this surgical procedure. Removing excess skin is performed in case of wrinkles in the skin in older patients in order to make the skin tauter. Procedural description of corrective eye surgery A form of brow lift is performed for this correction. Excess skin muscle if present is carefully excised before taking deep bites from the eyelid and eyebrow and suturing to the periosteum. Sagging skin under the eyes is also tightened as a secondary benefit arising from this procedure. The appearance of having droopy eyelids is corrected completely giving the patient a completely level gaze. Care should be taken to not impair vision in any way. Lateral canthopexy surgery is one of the most commonly performed procedures of blepharoplasty in India. This is classified under brow lift surgery procedures. Cosmetic surgery is undergoing a boom throughout the world. India in particular is fast turning into a hub for cosmetic eye surgery, cosmetic nose surgery and overall cosmetic face surgery in the world. Patient with antimongoloid slant is referred to our hospital for cosmetic eye surgery The patient is a young man with idiopathic antimongoloid slant of the eye. He hated the way his eyes appeared. His marriage got fixed recently and he finally decided to get the slant corrected. He approached a local plastic surgeon at a cosmetic eye center in his hometown who referred him to our hospital for correction of his antimongoloid slant as we are a specialty center for cosmetic eye surgery in India. Initial examination and treatment planning for the patient Dr SM Balaji, cosmetic eye surgeon, examined the patient and ordered detailed biometric studies including measurements for the golden ratio. He explained to the patient that he needed a lateral canthopexy for correction of his antimongoloid slant. This is a procedure that has the approval of the American Society of Plastic Surgeons for the correction of antimongoloid slant. The patient was in agreement with the treatment plan and consented for surgery. He explained that this procedure gave the best results for correcting the antimongoloid slant. The patient was informed that the decision might be made to remove excess skin if the need arose during surgery. Surgical correction of antimongoloid slant of the eyes Under general anesthesia, the patient was prepped and draped for surgery. Cosmetic eye correction surgery for antimongoloid slant of the right eye was performed first. An incision was made at the lateral canthus and extended outwards. The incision was then extended along the margins of the upper eyelid and also the lower eyelid. A suture was passed through the edge of the lower eyelid and secured to the periosteum of the orbital margin. The incision was then closed in layers using sutures to ensure minimal scar formation. This resulted in bringing the medial and lateral canthal margins to the same horizontal plane. Good esthetic results with symmetry of repositioned eyelids The same procedure was next performed on the left eye. Perfect symmetry of the eyes was ascertained at the end of the procedure. Care was taken to ensure that the eyes were never dry during any portion of the procedure. General anesthesia was reversed and the patient recovered without incident after the surgery. The patient expressed complete satisfaction at the results of the surgery before final discharge from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Dr Preetha Balaji receives the Young Maxillofacial Surgeon Award

Cosmetic eye surgery with lateral canthopexy for antimongoloid slant correction

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