Successful Flat Nose correction with CC graft
A patient of age 35 years presented to our hospital with a complaint of flat nose. He was very unhappy about his nose and requested for a prominent nose. Maxillofacial Surgeon Dr.S.M.Balaji planned to correct the nose by closed rhinoplasty. The nasal bridge height increased using cc graft harvested from the right inframammary region. Lateral osteotomy done bilaterally. Columellar strut graft placed to raise the height of the nose. Weir excision done to decrease the alar width. The patient had a very esthetic and pleasing appearance post surgery. He expressed his happiness and appreciated Dr SM Balaji and his team for the skillful correction.
RTA – Malunited Very old Fracture of Maxilla (Upper Jaw) and Zygoma (Cheekbone) with Enophthalmos Correction Surgery
Young man with residual facial deformities from motor vehicle accident This young man from Indore, Madhya Pradesh, was riding his bike when he collided with a car 1.5 years back. He suffered facial fractures involving the maxilla, zygoma and orbital region. The patient underwent surgical correction at a local hospital after the accident. This surgery left him with residual deformities. These included an anterior crossbite and a sunken right zygoma with enophthalmos. The patient presents to our hospital for specialized facial deformity correction Dr SM Balaji, facial deformity correction specialist, examined the patient. He ordered 3D CT scan and other imaging studies. There were many plates seen from the previous surgery. The maxilla was in a retruded position. He recommended advancing the maxilla forward with a Le Fort I osteotomy for crossbite correction. Other recommended surgeries were refracture of the zygoma with plate fixation. Release of herniated fat trapped in the right eye with Titanium mesh placement was also recommended for enophthalmos. The patient consented to surgery. Patient undergoes correction of anterior crossbite with Le Fort I maxillary advancement osteotomy Under general anesthesia, a buccal vestibular incision exposed the old maxillary plates. These were then removed and the maxilla advanced forward with a Le Fort I advancement osteotomy. This resulted in correction of the anterior crossbite. Four L-shaped four holed plates were utilized to achieve this. Enophthalmos and zygomatic depression correction done for the patient The enophthalmos and depression in the zygoma were then addressed. A right lateral canthal incision was first made. This was then followed by a right transconjunctival incision. Dissection down into the floor of the orbit exposed the herniated fat under the eye, which was freed. An old plate from the previous surgery was then removed through the lateral canthal incision. The zygoma was then refractured and repositioned with new plates. This resulted in correction of the depressed zygoma. The enophthalmos was then addressed. A Titanium mesh with Medpor was used to correct it. The Titanium mesh was then fixed with screws to the lower orbital rim. All incisions were then closed with sutures and the patient extubated. The patient expressed complete satisfaction at the results of the surgery before final discharge. Surgery Video
Maxillary augmentation, nasal notch correction and alar web correction surgery
A brief introduction to Tessier’s facial cleft and their management Tessier’s facial clefts are of 14 types. They can extend from the hairline above the forehead to the mandible. These malformations can be debilitating for the patient and distressing for the family. It requires extensive surgical correction to rehabilitate these patients. Tessier’s facial clefts can also include malformations of the brain. A patient with Tessier’s facial cleft presents to our hospital This young man was born with Tessier’s facial cleft. He has already undergone innumerable surgeries elsewhere in the past. A doctor in his hometown referred him to our hospital for further management. Dr SM Balaji, facial reconstruction specialist, examined the patient and ordered radiographic studies. The patient needed maxillary augmentation, nasal notch correction and right alar web correction. He explained that rib grafts were mandatory for this surgery. The patient and his parents consented to the surgery. Surgical correction of labial and infraorbital defect with rib grafts Under general anesthesia, rib grafts were first harvested from the patient. A Valsalva maneuver demonstrated a patent thoracic cavity. The incision was then closed in layers with sutures. Attention was next directed to the patient’s labial defect. There was heavy scarring of the buccal vestibular mucosa from the previous surgeries. Incisions were made in the vestibular region. A costochondral graft was then shaped and placed in the anterior maxillary region. Rib grafts were then used to augment the remaining maxillary defects. The grafts were then fixed with screws. Sutures were then used to close the incisions. Attention was next turned to correction of the nostrils. Notching on the left nostril was then corrected followed by right alar web correction. The incisions were then closed with sutures. The patient recovered without event from general anesthesia. The patient and his parents expressed their complete satisfaction at the results. Surgery Video
Upper Lip Reduction Surgery – Dr. S.M Balaji, Balaji Dental and Craniofacial Hospital, India
Patient with disproportionate upper lip presents at our hospital This patient is from Rohtak, Haryana. He was born with congenital disproportion between the size of his lips. His upper lip has always been everted and large. This had begun affecting his social life and his work life. He presented to our hospital for lip reduction surgery. Initial Examination and biometric analysis for treatment planning Dr SM Balaji, cosmetic lip surgery specialist, examined the patient. He obtained biometric measurements of the patient’s lips and face. Using various analyses, he determined the exact extent the upper lip needed reduction. He explained the surgical correction procedure in detail to the patient. The patient consented for surgery. Surgical reduction with removal of excess tissue from the upper lip Under general anesthesia, the region of lip that needed reduction was marked out. An incision was then made along the marking on the lip. This was then extended down into the submucosal region. Excess tissue was then dissected and excised from the region. The vermillion borders of the incision were then reapproximated with sutures. A two week postoperative visit was scheduled at the hospital. The patient expressed complete satisfaction at the results of the surgery. Surgery Video
Dr SM Balaji’s visit to the University of Buenos Aires Hospital on Dr Gotta’s invitation
Dr SM Balaji at the University of Buenos Aires Hospital’s Department of Oral Surgery Dr SM Balaji was invited by Prof Sergio Gotta, Head of the Department of Oral and Maxillofacial Surgery, University of Buenos Aires. He was given a guided tour of the Department of Oral and Maxillofacial Surgery by Prof Gotta accompanied by Dr Maricel Marini, Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial surgery and residents of the department. Prof Gotta explained to him the various measures that had been put in place for the benefit of the patients. Dr SM Balaji interacts with the staff of the hospital Dr SM Balaji spent some light hearted moments at the hospital cafeteria with Prof Gotta, Dr Marini and the residents. He later gave them complimentary copies of his Clinical Cranio Maxillofacial Surgery textbook and the current issue of the Annals of Maxillofacial Surgery, a Scopus indexed journal for which he is the Editor in Chief.
Road Traffic Accident (RTA) Upper Jaw (Maxilla) defect, Reconstruction for dental implant surgery
Patient with partial edentulousness presents for implants at our hospital This young man is from Ranchi, Jharkhand. A biking accident resulted in direct trauma to his jaws and oral cavity. He suffered fractures to both jaws as well as to many teeth. Fracture fixation and fractured teeth extraction was first performed elsewhere. This surgery resulted in a bony defect in the left maxilla. He desired complete oral rehabilitation with implant placement for missing teeth. Treatment planning presented to the patient after diagnostic studies The patient presented to our hospital for oral rehabilitation. Dr SM Balaji, Implant specialist and facial trauma specialist, examined the patient. He ordered a 3D CT scan and other imaging studies. This revealed a bony defect in the left maxilla. There was also a periapical cyst in the remaining left upper central incisor. He explained to the patient that the tooth needed to be extracted. Rib graft was necessary for implant placement in that region. The patient agreed to the treatment plan and consented for surgery. Successful left maxillary defect augmentation with rib graft Under general anesthesia, an inframammary incision was made to harvest a rib graft. A Valsalva maneuver was then performed to ensure patency of the thoracic cavity. The incision was then closed. Following this, a maxillary flap was then raised and the central incisor extracted. The periapical cyst associated with the tooth was then enucleated. Rib graft was then used to augment the left maxillary defect. It was crafted to the correct size and fixed with screws. Implants will be placed around six months after fusion of the rib graft to the underlying bone. Successful implant placement in edentulous regions of the oral cavity The edentulous regions of the oral cavity were then addressed. Implants were then placed. A bone graft was then placed in the anterior mandible to stabilize the anterior implants. Crown placement will be done in three month’s time after osseointegration is complete. All plates and screws from the previous surgery sites were then removed. All incisions were then closed with sutures. The patient recovered well from general anesthesia.
Craniosynostosis – Scaphocephaly Surgical Correction of the Frontal Bone and Bitemporal Compression
Child with scaphocephaly referred to our hospital for craniosynostosis surgery The patient is a 1-year old boy from Jaisalmer, Rajasthan with scaphocephaly. This is the simplest form of craniosynostosis. It involves fusion of the sagittal suture. His mother became very worried after observing an abnormal shape to his growing head. A consultation with a local neurosurgeon confirmed the diagnosis of scaphocephaly. This doctor referred them to our hospital for surgical management of the child. Patient scheduled for surgery after obtaining parental consent for surgery Dr SM Balaji, Craniosynostosis surgery specialist, examined the child along with his team of neurosurgeons. He ordered a 3D CT scan and other imaging studies. This confirmed the earlier diagnosis of scaphocephaly. He explained the effects and potential complications to the parents. There could include increased intracranial pressure, visual impairments, seizures and skull deformities. They were advised that these needed immediate treatment. The child’s parents were in complete agreement and consented to surgery. Mock surgery performed on 3D stereolithographic model of the patient’s skull A 3D stereolithographic model was first obtained of the patient’s skull. The anatomy of the patient’s skull was studied and a mock surgery performed on this model. Craniosynostosis surgery performed with adequate relief provided for growing brain The neurosurgical team was present and assisted throughout the entire operation. Under general anesthesia, a bicoronal flap was first raised and skin clips used to hold the flap. Markings were then made on the bone and a craniotome used to section the skull. The bone along the edges of the cut skull sections was removed. This would provide adequate relief for brain growth. Barrel stave cuts were then made on the bony sections to provide further relief. This would ensure development of the brain to its full size. Vicryl sutures were then used to hold the various bony sections in their correct place. The bicoronal flap was then closed using surgical staples. Vital signs were closely monitored throughout the surgery and were normal. Uneventful postsurgical course after craniosynostosis surgery on the child The child’s postoperative course was uneventful. He was very active and playful the day after surgery. They were then discharged with instructions to present in 12 days for staple removal. Normal parameters observed at the 12th day postsurgical appointment At the 12th day recall appointment, the patient’s postsurgical healing was normal. The surgical staples were then removed and the patient discharged. The patient will be monitored at regular intervals to ensure normal growth of the brain.
Bilateral Ear Reconstruction – Microtia – 1st Stage
Microtia deformity of the external ears Microtia is a congenital condition in which there in poor development of the ears. Correction involves staged reconstruction of the ear using autogenous costal cartilages. A template is utilized to create the form of the proposed external ear. Three surgeries complete reconstruction of the microtia affected ear. Patient presents to our hospital for specialized microtia surgery This is a young 13-year-old boy from Tirupati, Telangana with microtia. His parents brought him to our hospital for bilateral microtia repair. Dr SM Balaji, microtia repair specialist, explained the surgery to them. They agreed to proceed with surgery. Microtia surgery of bilateral ears performed for young boy from Tirupati After general anesthesia, rib grafts were first harvested. Grafts obtained were from the fourth, fifth and sixth ribs. A Valsalva maneuver was then performed. This was to rule out accidental perforation into the thoracic cavity. Using a metal template, the sixth rib graft was first carved and sculpted to form the external ear framework. This was done for both the right and the left sides. The other graft pieces were then fixed and secured with nonresorbable sutures. Care was taken to maintain symmetry between the frameworks of both ears. The skin of the right ear was first incised and underlying tissues dissected to create a pocket. The framework of ribs was then tunneled into the pocket. Skin was then sutured and surgical drain placed at the site. This step will help adapt the skin to the cartilage framework. The left ear was then addressed. Second stage repair will be after about 3 months. This will be for elevation of the framework inserted in the first stage.
Nose Defect – Augmentation with Rib Cartilage graft
A patient presents for broad nose correction This young man from Arani in Tamil Nadu never liked his nose. He had already undergone rhinoplasty elsewhere. They had used cartilage graft from the ear. Following surgery, he still felt that his nose was very broad and flat. He desired corrective surgery and presented to our hospital for management. Patient consents to surgery after treatment plan explained Dr SM Balaji, rhinoplasty specialist examined the patient. He explained the treatment plan in detail to the patient. This involved harvesting a rib graft. The patient consented to surgery. Harvesting of rib grafts for nasal bridge augmentation Under general anesthesia, a rib graft was first harvested from the patient. A Valsalva maneuver was then performed to confirm patency of the thoracic cavity. The incision was then closed in layers. Correction of saddle nose deformity through rhinoplasty Attention was then turned to the saddle nose deformity. A transcartilaginous incision was first made. Tunneling was then done to the bridge of the nose. The rib graft was then inserted to augment the bridge of the nose. Attention was next turned to the broad ala. An elliptical incision was then placed in the right alar crease. Excess tissue was next excised from this region and the incision sutured. The patient expressed complete satisfaction at the results of the surgery.
Azerbaijan Society of Oral and Maxillofacial Surgeons Presentation Ceremony
Dr SM Balaji invited to attend the presentation ceremony of the Azerbaijan Society of Oral and Maxillofacial Surgeons (AzSOMS) Dr. SM Balaji was invited to the presentation ceremony of the AzSOMS. This was held at the Oral and Maxillofacial Surgical Clinic of the Azerbaijan Medical University in Baku. Prof. Chingiz Rahimov, President, AzSOMS, had extended this invitation to Dr. SM Balaji. This was in recognition of his services and contributions towards craniomaxillofacial surgery. Dr SM Balaji introduces the International Cleft Lip and Palate Foundation to the audience As the authorized representative of the International Cleft Lip and Palate Foundation (ICPF), Dr. SM Balaji introduced the ICPF to the audience. He spoke about his passion towards the rehabilitation of children born with cleft lip and palate. Dr. SM Balaji also spoke about his extensive involvement with the International Cleft Lip and Palate Foundation. He described how the organization has touched the lives of patients with cleft lip and palate through its humanitarian surgical missions to poor nations. Dr. SM Balaji’s keynote speech on the Management of Craniofacial Clefts Dr. SM Balaji delivered the keynote speech on the topic of the Management of Craniofacial Clefts. He described key cases from his over 30 years of experience performing craniofacial surgeries. His keynote speech documented innovations made by him that led to significant improvement in the quality of life of the patients. The interactive Q&A session at the end of his keynote speech was very lively. Audience members asked him many questions on the management of craniofacial clefts. Prof SM Balaji answered all the questions with a depth that only comes from experience. Dr SM Balaji urged the residents of Oral and Maxillofacial Surgery to take up a career in treating craniofacial clefts. He said that the satisfaction of rehabilitating a child afflicted with such severe deformities is second to none. Dr. SM Balaji’s meeting with the Rector, His Excellency Dr. Garay Chingiz Garaybayli Dr SM Balaji then met with the Rector of Azerbaycan Tibb Universiteti, His Excellency Dr Garay Chingiz Garaybayli. He spent time with the Rector discussing issues pertaining to craniofacial surgical care. The Rector evinced a deep interest in Dr. SM Balaji’s opinions on the subject. Dr. SM Balaji presented the Rector with a copy of his “Clinical Craniomaxillofacial Surgery” book at the end of the meeting.