Fracture of the lower jaw open reduction and fixation surgery
Open bite from displacement of reduced fracture This young man is from Chennai, Tamil Nadu. He had a bike accident a week ago. Direct impact to his mandible resulted in a fracture of the mandible. He sustained facial injury as a result of this accident. This resulted in inability to close his mouth with an open bite. There were no soft tissues injuries from this accident. The patient never lost consciousness. He remained lucid during the immediate period after the fracture. Examination by a neurologist revealed no signs of head injury in the patient. The neurologist explained to the family that the helmet had saved the patient’s life. He explained through charts how the injuries would have been very severe if the patient had not been wearing his helmet. Presentation at our hospital for management of fracture His family wanted the best treatment for his jaw fracture. They made enquiries about the best jaw fracture surgeon in India. He was then brought to our Balaji Dental and Craniofacial Hospital for treatment. Our hospital is a premier hospital for jaw fracture surgery in India. Success rate of surgery for mandibular fractures at our center is amongst the best in India. Our hospital is a specialty maxillofacial surgery center. We deal with cases of maxillofacial trauma on a daily basis. Our center is a top referral center among city plastic surgeons. Special training through workshops are a regular feature at our hospital. Many oral and maxillofacial surgeons undergo this training. Fractures of the bones of the face are a common feature at these workshops. Injuries to the face are a common occurrence in the city. Treating these injuries needs the utmost care. Treatment plan presented and consent obtained from patient Dr SM Balaji, facial trauma surgeon in India, examined the patient. He obtained imaging studies for the patient. There was no fracture involvement of the eye sockets. There was no involvement of other facial bones or soft tissue. Any dental implants along the fracture line would need removal if present. Fracture was only at the left mandible. This came under the classification of facial fractures. There had been no facial lacerations from the accident. Location of the fracture determined his treatment plan. Rigid fixation was essential for fracture stability. Fracture treatment would be through open reduction and internal fixation. This decision was based upon his experience with jaw fractures correction. The patient consented to the treatment plan. All appropriate consents were next signed by the patient and surgery scheduled. Open reduction versus closed reduction Open reduction and closed reduction are two ways of setting a fractured bone. The fractured segments of the bone stay reduced when it is a favorable fracture. The anatomy of the fracture ensures this. Certain fractures can be reduced without any skin incisions. These stay in place without displacement with plaster casts alone. This is a closed reduction. The break has to be clean without comminution of the fracture. Fractures that do not stay reduced need open reduction and internal fixation. An incision is first made to gain access to the fracture site. Titanium plates and screws are then used to fix the fragments of bone to each other. This results in stabilization of the fracture. Incisions used to access the fracture are then closed with sutures. This is then followed by a period of immobilization for consolidation of bone. A closed reduction is possible only in a favorable fracture. All other fractures need open reduction and internal fixation. Fractures of the mandible can be favorable or unfavorable fractures. Favorable mandibular fractures stay stabilized with closed reduction and intermaxillary wiring. Care should be taken to maintain proper occlusion of the teeth. These fractures heal without any further intervention. Unfavorable mandibular fractures can comprise of several fracture segments. These do not stay stabilized with closed reduction. They need correction through stabilization with titanium plates and screws. An incision is first made to access the fracture site. The fracture fragments are then brought together into proper anatomical alignment. Titanium plates and screws are then used to stabilize the fracture. Occlusal harmony of the teeth should be ensured before final closure. The patient needs to return for periodic checks for a prescribed period of time. Full bone consolidation at the fracture site ensures complete healing of the fracture. The number of plates used for fracture reduction would increase with fracture severity. Successful open reduction and internal fixation of the fracture Under general anesthesia, a left vestibular incision in the mandible exposed the fracture. The fracture segments were then brought into correct alignment and occlusion checked. The fracture was then stabilized with plates and screws. Incisions were then repaired by suturing. The patient expressed his satisfaction at the results of the surgery before discharge. He was able bring his teeth together. The open bite had undergone complete resolution. Facial esthetics was also perfect and there was no residual asymmetry. Surgery Video
Recurrent odontogenic keratocyst total enucleation and reconstruction surgery
Patient treated elsewhere for bilateral OKC four years ago with enucleation and resection This patient is from Hyderabad, Telangana. He had undergone surgery elsewhere four years for bilateral mandibular odontogenic keratocysts. These cysts form in the bones of the jaws. This type of cyst has to be surgically removed. They are not like sebaceous cysts, which are minimally invasive. These cysts are comparable to polycystic ovaries in nature. Polycystic ovary syndrome converts the ovaries into fluid filled sacs. Ovarian cysts are always removed with care taken to preserve all surrounding internal organs. The patient carries the diagnosis of Gorlin-Goltz syndrome. Occurrence of many odontogenic keratocysts is a feature of this syndrome. This is very uncommon and is an autosomal dominant inherited disorder. The patient underwent bilateral enucleation and reconstruction of his mandible. Oral and maxillofacial surgeons remove these cysts. Patient returns with pain in the left side of his mandible Four years later, the patient noticed a swelling with pain in his left lower jaw. The patient was then referred to our hospital for treatment of his condition. Dr SM Balaji, an expert in mandibular reconstruction in India, examined the patient. Balaji Dental and Craniofacial Hospital is a premier center for mandibular cyst removal surgery in India. He ordered diagnostic studies including a 3D CT scan. This revealed recurrence of the odontogenic keratocyst on the left side. He explained that total enucleation was the best way for removing the cyst. The patient consented to surgery after a detailed review of this. Enucleation of OKC followed by reconstruction with rib grafts The surgical procedure commenced after general anesthesia. Rib grafts were first obtained through the old inframammary scar. A Valsalva maneuver confirmed patency of the thoracic cavity. The incision was then closed with sutures. Following this, a left sided vestibular incision was next made. The OKC was then thoroughly enucleated from the mandible. The cyst wall lining was carefully removed completely from the lingual surface of the mandible. Care was taken to ensure there were no remnants of cyst wall lining left behind. The mandible was then reconstructed using the rib grafts, titanium plates and screws. The incision was then closed with sutures. The patient recovered well from general anesthesia. The patient will need periodic checkups over the next few years. This will be to ensure that there is no recurrence of the OKC. The patient’s facial reconstruction surgery had good results. Surgery Video
Unilateral cleft lip surgery using Modified Millard’s technique
[et_pb_section fb_built=”1″ _builder_version=”3.22″][et_pb_row _builder_version=”3.25″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.9.0″ _module_preset=”default” text_font_size=”16px”] Cleft Lip Surgery in India Initially, Indian Plastic Surgeon Dr. Sushruta performed cleft lip surgery in India in the 8th century B.C. He is considered the “Father of Plastic Surgery”, A Cleft lip is a birth defect: A cleft lip may only be a tiny notch in the lip. There may also be a complete split in the lip that goes all the way to the base of the nose. The cleft palate may be on one or both sides of the roof of the mouth. It may be the entire length of the palate. Your child may have either or more of these birth conditions. Procedure of Cleft Lip Surgery in India Cleft lip repair is typically performed when the infant is 3 to 6 months old. Your child will have general anesthesia for cleft lip surgery (asleep and not feeling pain). The surgeon will trim the tissues and stitch the lips together. The stitches are going to be very small so that the scar is as small as possible. Many stitches will be absorbed into the tissue when the scar heals, so they won’t have to be removed later. Procedure of Cleft palate Surgery in India Cleft palate repair is typically performed when the child is older, between 9 months and 1 year of age. This causes the palate to shift as the child grows. Doing the repair when the child is this age will help prevent further speech problems as the child develops. In cleft palate repair, your child will have general anesthesia (asleep and not feeling pain). Tissue from the roof of the mouth may be moved over to cover the soft palate. Often a child may require more than one surgery to close a palate. The surgeon may also need to repair the tip of your child’s nose during these procedures. The surgery is called rhinoplasty. Baby girl from Mathura This is a 3-month old baby girl from Mathura born with unilateral cleft lip. She also had a hole in the roof of the mouth involving the upper jaw (hard and soft palate). The patient’s mother was a known case of cleft lip and palate. There was also a familial history of clefts running through the generations. Unilateral cleft lip Cleft lip is a congenital split in the upper lip on one side often associated with cleft palate. Babies with cleft lip usually have difficulty in feeding. They may develop ear infections which may lead to hearing loss. Cleft lip surgeon in India Though aware of the condition the parents were very depressed. They felt that the lip and nose deformity might affect her future. The parents were planning to do cleft lip surgery in India. They were searching far and wide for the best cleft lip surgeon in India. A local physician referred them to our hospital. Dr. SM Balaji one of the leading cleft lip and palate surgeons in India examined the patient. He planned to perform surgical repair of the cleft lip at 3 months of age. Primary cleft lip repair Cleft lip and palate surgeon Dr. S.M. Balaji planned to perform primary lip repair at the age of 3 months. Unilateral cleft lip surgery is done using Modified Millard’s technique under general anesthesia. The cleft and plastic surgeons usually prefer this surgical procedure for children with cleft. Surgical Results: The result of the surgery was as expected. She looked like any other baby girl of her age with minimal to no scar. The parents were very pleased with the results. Cleft palate repair (cleft palate surgery) will be done at about 9 months of age. Alveolar Cleft defect reconstruction surgery with bone grafts will be planned at 3.5 years of age. [/et_pb_text][et_pb_gallery gallery_ids=”5264,5265,5266,5267,5268″ fullwidth=”on” _builder_version=”4.9.0″ _module_preset=”default”][/et_pb_gallery][/et_pb_column][/et_pb_row][/et_pb_section]
Cheekbone fracture surgery and lower eyelid correction
Patient with facial injuries This is a 35-year-old patient from Jharkhand. He was hit by a speeding car which resulted in facial trauma before 2 years. The facial trauma resulted in facial bone fractures. He underwent emergency treatment for cheekbone fracture and lower eyelid correction in Jharkhand. The patient was not happy with the outcome of cheekbone fracture surgery. He complained of depressed cheekbone in the left side of the face. He requested for further cheekbone correction. Ectropion of eye He also complained of double vision in one eye (left) and lower eyelid drooping. His lower eyelid was sagging outwards thereby exposing the surface of the inner eyelid. There was noticeable difficulty in closing his left eye. He requested left lower eyelid surgery. The patient’s eye doctor had neglected the need for a second surgery. He advised him to use eye drops every day to prevent drying up of the left eye. Cheekbone fracture surgery in India Complete clinical and radiological evaluation done. Oral and Maxillofacial surgeon Dr. SM Balaji diagnosed malunited cheekbone fracture. He had hypoglobus and ectropion of the left eye. There was also a left orbital floor fracture which led to herniation of the orbital contents. Dr. SM Balaji the leading facial reconstructive surgeon in India planned to correct all his problems in one surgery. Fracture treatment along with ectropion correction Incision placed through the previous surgical scar. Layers dissected, thereby exposing the previously placed plates and screws. Removal of plates and screws done. The malunited cheekbone fracture was re-fractured. Re-fractured segment elevated and fixed using plates and screws. The floor of orbit reached. The herniated orbital floor contents released. Left orbital floor reconstruction surgery done using Titan Medpor implant. The implant was fixed using screws. Malpositioned lower eyelid released from the scar tissue. The ectropion of the left eye was also corrected using a medial canthal incision. Surgical outcome The check bone fracture corrected. The lower eyelid raised and reattached to its normal position. The orbital floor was also reconstructed successfully. The patient was happy with the outcome of the surgery.
Hypertelorism Surgery with Frontonasal Encephalocele, Dr SM Balaji
Patient born with craniofacial deformities and cleft lip and palate This young man is from Ambala, Punjab. He had been born with marked craniofacial deformities and a cleft lip and palate. Cleft lip and palate repair performed as an infant were satisfactory. His marked nasal deformity had resulted in hypertelorism. There was also soft tissue scarring. His parents’ search for the best craniofacial surgeon for hypertelorism in India had led them to our hospital. Our hospital is well known for hypertelorism surgery in India. Orbital hypertelorism surgeries are a division of facial reconstructive surgery. We are one of the best for facial reconstructive surgery in India. These surgeries are also performed by plastic surgeons in EU nations. Treatment plan explained to the patient and his parents in detail Dr SM Balaji, Craniofacial deformity surgery specialist, examined the patient. The neurosurgical team assisted throughout this process. A 3D stereolithographic model was first obtained of the patient’s skull. A detailed study was then conducted followed by a mock box osteotomy procedure. Once the treatment plan decision had been made, this was then explained to the patient. The patient and his parents consented to surgery. The patient undergoes box osteotomy procedure for hypertelorism correction Under general anesthesia, a lumbar puncture was first performed and CSF drain placed. This was to ensure adequate control of intracranial pressure. A bicoronal flap was then raised. Following this, a craniotomy was then performed 2 cm above the supraciliary arches. The posterior cut was anterior to the coronal sutures. The squamous part of the frontal bone then removed and preserved for later placement. The frontal lobe of the brain was then exposed and around 60 mL of CSF drained. This was to decompress the brain for better surgical access. This aided in retraction of the frontal bone from the floor of the anterior cranial fossa. An osteotomy was then done parallel to the craniotomy cut to create the frontal bar. Temporalis muscle retraction aided in visualization of the inferior orbital fissure. This was then followed by bilateral osteotomies of the zygomatic arches. A transverse osteotomy was then done across the roof of the orbit. Final maxillary Le Fort I osteotomy through intraoral incisions resulted in complete disengagement of the midface. Bone was then removed from the lateral and medial regions of the orbit. Careful positioning of the bone resulted in correction of the hypertelorism. The repositioned bone segments were then stabilized with plates to the frontal bar. Intraoral incision was also closed with sutures. Treatment plan for closure of frontonasal encephalocele discovered during surgery A frontonasal encephalocele had been discovered during this stage of the surgery. There was congenital absence of duramater in this region. This could result in herniation of brain tissue at a later date. The neurosurgical team advised closure of this cavity with fat graft. Fat graft and fibrin glue utilized for closure of frontonasal encephalocele A fat graft was thus obtained from the patient for this purpose. This incision was then closed with staples. A layer of fat graft was first laid over the opening. The fat graft was next covered with fibrin glue followed by another layer of fat graft. This resulted in complete closure of the defect in the bone. The bony segments of the skull were then placed back into correct position. These segments were then fixed in position with four holed plates. The bicoronal flap was then stapled back into position. Successful completion of the first stage of the patient’s rehabilitation This completed the first stage of the patient’s surgical correction. The second stage would involve correction of the nasal deformity. The patient recovered well from surgery and was then discharged home. Surgery Video
Medial blowout fracture correction surgery for orbital volume increase plus ptosis correction by reattachment of levator palpabrae superioris
Road traffic accident leaves patient with a sunken left eye This young woman is from Tirupur, Tamil Nadu. A road traffic accident resulted in injury around the left eye. This had resulted in a blowout fracture of the left eye. Surgery elsewhere resulted in a sunken left eye and residual ptosis. This was the result of fat herniation into a medial orbital wall fracture. A local oral surgeon referred her to our hospital for surgical correction. Treatment planning explained to patient and consent obtained Dr SM Balaji, facial deformity correction specialist, examined the patient. He explained that the sunken eye was due to herniated fat. The patient also needed ptosis correction. He explained that levator palpabrae superioris muscle needed corrective surgery. The patient consented to surgery. Osteomesh utilized for correction of fat herniation into medial wall fracture After general anesthesia, the medial wall of orbit fracture was first accessed. Herniated fat was then released from the fracture site. An Osteopor-Osteomesh was then inserted to cover the fracture site. This would form a permanent film over the fracture site. Fat herniation would thus not recur at the fracture site. Fine ophthalmic sutures were then used to close the incision. Ptosis surgery done with full correction of deformity The levator palpabrae superioris was next addressed. An incision was first made at the old scar site. The muscle was then accessed and a suture used to attach it to the orbicularis oculi. This incision was also closed with fine sutures. The patient’s eye function was then tested after recovery from general anesthesia. The patient had symmetrical eyes with correction of the left eye ptosis. The patient expressed her satisfaction before discharge from the hospital.
Supraorbital rim Fracture Open Reduction Internal Fixation (ORIF) Surgery
Patient suffers a comminuted frontal bone fracture from trauma The patient suffered a trauma to the right supraorbital region. This resulted in a comminuted fracture of the supraorbital region with involvement of the rim. He presented to our hospital for definitive management of his fracture. Examination of the patient with treatment plan presentation Dr SM Balaji, facial trauma care specialist, examined the patient and ordered a 3D CT scan of the region. This demonstrated a comminuted supraorbital fracture of the frontal bone. The treatment plan was then explained to the patient who consented to surgery. Surgical correction of comminuted frontal bone fracture with four hole plates Under general anesthesia, the fracture was first approached through a supratarsal fold incision. The supraorbital rim fracture segments were then elevated and stabilized. Two Titanium four hole plates and screws were then used to fix the rim fracture. Another incision was then made superior to the left eyebrow. The supraorbital fracture segments were then elevated and stabilized. Another four hole plate was then utilized to fix the supraorbital fracture segments. Both incisions were then closed with sutures. Care was taken to protect the supraorbital nerve throughout the surgery. Successful rehabilitation of the patient after comminuted frontal bone fracture There was no residual deformity of the region after surgery. The patient expressed total satisfaction at the results of the surgery before discharge.
Successful nose correction with no scars | Rhinoplasty Surgery in India
A 22 year old girl from Mumbai visited our hospital with complaint of broad and bulky nose. She was very unhappy with her nose and had inquired about her nose with a local surgeon who referred her to our hospital. She requested for a narrow nose with a sharp tip. Maxillofacial surgeon Dr.S.M.Balaji examined the patient. She had a broad dorsal base with bulky nasal tip. He planned to correct the nose by closed rhinoplasty technique. The lateral nasal cartilages were removed by transcartilaginous incision. Lateral osteotomy was done bilaterally. The patient was overjoyed with the results and expressed her joy to the surgeon.
RTA 5 months old Fracture Malunion of Upper jaw Resurgery with Rhinoplasty
Emergency surgery after RTA results in open bite and flattened bridge of nose This young lady is from Salem, Tamil Nadu. A road traffic accident five months ago resulted in fractures to her maxilla and a comminuted nasal bone fracture. Emergency surgery elsewhere left her with a flattened bridge of the nose and an open bite. Feeling very dissatisfied, she approached a local surgeon who referred her to us. Le Fort I osteotomy surgery planned to correct open bite Dr SM Balaji, nose correction and facial deformity correction specialist, examined the patient. He ordered imaging studies for the patient. He decided on a LeFort I maxillary osteotomy for the open bite correction. Treatment plan was then explained to the patient in detail. The patient was in agreement and consented to surgery. Open bite surgery and rib graft for correction of flattened nose Under general anesthesia, a rib graft was first harvested. A Valsalva maneuver demonstrated a patent thoracic cavity. The incision was then closed with sutures. Attention was next turned to the maxilla. A vestibular incision was then made exposing the maxillary bone. Plates used in the previous surgery were then removed. A LeFort I maxillary osteotomy was next performed. Arch bars were next wired to both jaws for stabilization. Following this, the vestibular incision was then closed with sutures. The flattened bridge of nose was then addressed. The rib graft was first crafted to the right size. It was then tunneled to the bridge of the nose through a transcartilaginous incision. This resulted in a straight profile to the patient’s nose. The incision was then closed with sutures. The patient expressed complete satisfaction before discharge from the hospital. Surgery Video
Corrective surgery for protruding upper jaw
A 25-year-old girl from Mumbai reported to our hospital with complaints of forwardly placed upper and lower jaw. The patient also complained about her gummy smile. She had difficulty in closing her mouth and was very self-conscious of her looks. Radiographic analysis of the facial bones showed that she had a prognathic maxilla and mandible. Maxillofacial surgeon Dr. S.M. Balaji planned to perform Lefort I osteotomy followed by subapical osteotomy. The excess bone from the upper jaw was removed & the jaw was set backwards and upwards in proper alignment with the lower jaw. The anterior portion of the lower jaw was setback using Kole’s technique. The results were spontaneous and she was overjoyed with her new look.