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Cleft Palate – Velopharyngeal Incompetence – Hypernasality Speech Correction Surgery – Pharyngoplasty

A patient with velopharyngeal insufficiency presents to Dr SM Balaji The patient had been born with a cleft lip and palate. This had been set right as an infant. She later developed velopharyngeal incompetence. This is where there is escape of air through the nose during speech. It also manifested as difficulty pronouncing certain words well. This also added a nasal twang to her voice. She searched far and wide for the right cleft lip and palate surgeon to correct her problem. The patient was then referred to Dr SM Balaji. He is a world renowned cleft lip and palate surgeon. Surgery planned for the patient Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined her. He explained to her that she needed a pharyngoplasty surgery to correct this. The patient was in agreement with this and was then scheduled for surgery. Aim of this surgery is to create a dynamic sphincter in the pharynx. Repositioning of the palatopharyngeus muscles achieves this. The surgical procedure The patient was then taken to the operating room. She then underwent general anesthesia without complications. Incisions were then made to release the posterior faucial pillars. This included the palatopharyngeus muscles. These muscles were then crisscrossed and sutured together on the posterior pharyngeal wall. A sphincter was thus formed here. This left a small opening or “port” for breathing through the nose. Successful positive suction test A positive suction test was then performed after completion of the surgery. This demonstrated a new dynamic velopharyngeal sphincter action. Correction of the patient’s velopharyngeal incompetence was thus completed. The patient expressed total satisfaction with the results of the surgery. She was then discharged from the hospital.

Read moreCleft Palate – Velopharyngeal Incompetence – Hypernasality Speech Correction Surgery – Pharyngoplasty

Unilateral Cleft Lip Correction Surgery – Suture Removal on 7th day

Initial Presentation: This is a 2-month-old baby boy from Sri Lanka who was born with a unilateral cleft lip and palate defect. His parents related that his elder sister had also been born with the same condition. She had been operated on elsewhere in India, but the surgery had left behind ugly residual scars. So when their son too had been born with a similar deformity, they wasted no expense in searching far and wide for a cleft lip repair specialist. They finally zeroed in on Balaji Dental and Craniofacial Hospital, Teynampet, Chennai after extensive research done over the Internet and meeting parents of previous patients. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, explained to them that the child needed primary cleft lip repair surgery using the modified Black’s technique in order to recreate a tight lip seal. A modified Black’s technique cleft lip repair was done. Suture Removal: Seven days after the surgery, the parents presented with the boy at the hospital for suture removal. There was perfect vermillion border approximation, good columellar form and good overall appearance. There was negligible scar formation, which would slowly fade away over time. The baby was also feeding well. Both esthetic as well as functional outcomes of the surgery were good. Complete Rehabilitation: It was explained to the parents of the boy that he would need further surgeries in the future, which would have to be planned out in a phased manner for further correction of his cleft defects.

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Dr. S.M. Balaji invited as key operating faculty to the Advanced Craniofacial Surgery Workshop of the Indian Academy of Maxillofacial Surgeons

Indian Academy of Maxillofacial Surgeons’ Advanced Craniofacial Surgery Workshop The Indian Academy of Maxillofacial Surgeons conducted a workshop in Jabalpur. It was an Advanced Craniofacial Surgery workshop. Topic was “Current Advances in Cranio-Maxillofacial Surgery”. Hitkarini Dental College and Hospital & Jabalpur Hospital and Research Centre were the hosts. Duration of the workshop was from February 15-18, 2018. Many leading Cranio-Maxillofacial surgeons from around the world participated in this workshop. Prof J N Khanna was the programmed director. The programme coordinator was Dr Rajesh Dhirawani. Foreign Faculty at the Workshop Prof G E Ghali, Chancellor & Dean, LSU Health Sciences Center was the chief mentor at the workshop. He is the Gamble Professor and Chairman, Oral and Maxillofacial Surgery -Shreveport, USA. Dr Ghali was present with his entire team of key opinion leaders at this huge workshop. Other foreign faculty were also present at the workshop. Prof Andrew Meram, Dr Mary Laura Hastings, Dr Ahmed Tamim and Dr Hendell Nealy were also present. Dr S M Balaji Invited for Demonstration of Congenital Facial Palsy Correction Surgery Prof S M Balaji was a key operating faculty at this workshop. His surgery was a case of congenital facial palsy. He taught the audience the finer aspects of the facial reanimation procedure. Planning for the Dynamic Temporalis Sling Surgery The patient was a middle aged male. He had congenital facial palsy and was facing a lot of health and social issues due to the facial palsy. Due case selection and studies were exacting and precise. Study of all clinical and anatomical factors was the basis of treatment planning. Inference was that a dynamic facial reanimation surgery would provide best results. This would be by means of using a Tensor fascia lata graft along with a partial Tarsorrhaphy. Surgery would join a part of the upper and lower eyelids. This would close the eye to a certain degree. About 200 postgraduates and young oral surgeons presented for the workshop. They were from all over India. The surgery was a live demonstration. There was constant interaction between the surgeons and the audience. Audience would ask questions while the surgery was in progress. The operating faculties would immediately answer them. Live Surgical Demonstration with Commentary by Prof S M Balaji The patient suffered from a congenital lower motor neuron type of paralysis. Planned correct of this condition was via a strip of fascia lata. This was first harvested from the vastus lateralis. Next step of the surgery was by the combined preauricular and intraoral approach. Release of the temporalis from the coronoid process insertion was then performed. This was in the infratemporal region. The zygomatic arch was then cut and pushed down to free the temporalis muscle. Care was then taken to preserve all vital structures such as the parotid duct and gland in this area. Meticulous dissection ensured no damage to the the deep temporal artery and nerve. Through careful manipulation, the lower end of temporalis was then identified. One end of the fascia lata was then attached to it. Access to the modiolus was through a nasolabial incision. Free end of the fascia lata was then split into three parts. The lower part was then connected to the muscles of the lower lip. This was then followed by attaching the middle part to the modiolus and the upper part to the upper lip. Dynamic facial reanimation check ensured proper connections and secure muscle attachments. This was through the action of the muscles. Movements were satisfactory. The connections were then checked again. Muscle attachments were secure and dynamic facial reanimation was fine. Confirmation of this was through the action of the muscles. A partial lateral tarsorrhaphy was then performed to correct improper eye closure. The patient recovered well. Post-surgical Conference by Dr S M Balaji: Prof S M Balaji’s interaction with the audience was educational and informative. The audience had a lot of questions about the procedure. The surgical tips he gave the audience about the case were very useful and practical. The audience was appreciative and the surgery was well received by all at the workshop. Dr Ghali and Dr Dhirawani giving Dr S M Balaji a warm send off at the end of the workshop.

Read moreDr. S.M. Balaji invited as key operating faculty to the Advanced Craniofacial Surgery Workshop of the Indian Academy of Maxillofacial Surgeons

OKC – Odontogenic Keratocyst Hemimandibulectomy with total Reconstruction of Jaw (Ramus & Body of Mandible)

The patient’s presentation and history: This young 13-year-old Northeastern girl was brought to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, by her parents for treatment of a painless swelling involving the right side of her lower jaw that had been present for over a year. Her parents had not taken this slowly developing swelling seriously for a very long time and had neglected going to a doctor. It was only when it had grown to a very large size that they decided to seek medical help for their daughter. Search for a good surgeon: They had approached many hospitals throughout India, including premier surgical centers in other metropolitan cities, but had been turned away because of the extent of the lesion in her mandible. It was only after many months of futile search that they were finally referred to Balaji Dental and Craniofacial Hospital in Chennai for management of their daughter’s condition. Initial visits with Dr SM Balaji: Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient and ordered extensive investigations including 3D axial CT scans. Radiographic studies revealed the presence of an odontogenic keratocyst in the right side of the mandible, which involved both the ramus and the body of the mandible. It had spread so extensively that it had completely breached through the cortical bone of the ramus of the mandible into the soft tissues surrounding it. Dr. Balaji explained to the patient and her parents that except for the condylar region, the right side of the mandible would have to be completely removed because of the extent of the lesion. He further explained that the mandible would then be reconstructed using a titanium plate with costochondral rib grafts obtained at the same surgery. The parents were in full agreement with this treatment plan and the patient was scheduled for surgery. Obtaining Rib Grafts: After the successful induction of general anesthesia, two costochondral rib grafts were harvested from the patient. The incision was then closed in layers after a Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. Reconstructive Surgery: A right sided mucogingival flap was then raised and reflected down to the vestibular sulcus. The flap was reflected until the affected areas involving the body of the mandible was exposed. An extraoral incision was then made at the region of the angle of the mandible and dissection was carried down to the ramus. The bone in the affected regions was extremely soft and friable. A hemimandibulectomy was then performed with complete removal of the affected segment of the mandible. Reconstruction of the mandible was then performed with use of the costochondral rib grafts and the titanium plate. The incisions were then sutured close and the patient recovered uneventfully from general anesthesia. Postoperative Period: The patient and her parents expressed their thankfulness to Dr SM Balaji before being discharged from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

Read moreOKC – Odontogenic Keratocyst Hemimandibulectomy with total Reconstruction of Jaw (Ramus & Body of Mandible)

Bilateral cleft lip correction surgery suture removal on 7th day

Surgical Planning: This is a 2-month-old baby girl from Bahrain was born with bilateral cleft lip and palate. Her parents were referred to Balaji Dental and Craniofacial Hospital, by a close friend of theirs whose daughter had been operated upon by Dr. Balaji with very good results. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, explained to them that the goal of this primary surgery is to recreate the lip seal. The parents consented and the child was scheduled for surgery. A modified Black’s technique cleft lip repair was done. Suture Removal: Seven days after the surgery, the parents presented with the baby for removal of sutures. There was very good approximation of the vermillion, structural appearance of the columella and nice overall appearance to the nose. She was taken to the operating room where the sutures were removed. There was very negligible scar formation and the final appearance of the baby girl was good with satisfactory functional outcome. It was explained to the parents that subsequent phased surgeries will have to be done for correction of the other defects.  

Read moreBilateral cleft lip correction surgery suture removal on 7th day

Prof S M Balaji conferred the Craniofacial Research Fellowship Award by the Craniofacial Research Foundation at Paro, Bhutan.

Dr S M Balaji invited to confer Craniofacial Research Fellowship Award: Dr S M Balaji was invited to the 3rd International Craniofacial & Dental Summit held from March 4-6, 2018, in Paro, Bhutan, as he was being conferred the Craniofacial Research Fellowship Award by the Craniofacial Research Foundation in recognition of his outstanding contributions towards building awareness of craniofacial surgery and advancing knowledge of craniofacial surgical techniques.   Prof. S.M. Balaji honored by being Chairperson for Inaugural Lecture at the Summit: Prof. S.M. Balaji was given the honor of being the chairperson for the inaugural lecture of the summit by Prof. Warren Schubert, member, Board of Trustees, American Society of Maxillofacial Surgeons, on the topic of “Orbital Reconstruction.” Dr. S.M. Balaji’s Keynote Speech on Management of Craniofacial Clefts: Prof. S.M. Balaji was also invited by the Organizing Chair, Prof. Samdrup Wangchuk, Secretary to the Ministry of Health, Royal Government of Bhutan and Scientific Chair, Prof. Divya Mehrotra, Professor, King George Medical University, Lucknow to deliver a keynote guest lecture on “Management of Craniofacial Clefts.”Dr. S.M. Balaji spoke at length on the topic, drawing from his vast experience of 20+ years as a craniofacial surgeon, elucidating the way the field has evolved over the years and the latest research that is being done to advance the frontiers of the superspecialty to further serve patients with craniofacial deformities. Prof. S.M. Balaji’s presentation included latest craniofacial corrective surgeries performed on patients with various Tessier’s craniofacial clefts. Other Faculty at Summit: Other eminent keynote speakers at the summit included Prof. Francis V. Roasa from the Phillipines, Prof. Ravi Kant, ex-Vice Chancellor, King George Medical University, Lucknow and Director, All India Institute of Medical Sciences, Rishikesh and Prof. Jeff Downie, member, British Association of Oral and Maxillofacial Surgeons. Prof. S.M. Balaji’s appointment as Honorary Consultant Surgeon by the Government of Bhutan: Prof. S.M. Balaji was invited by Mr. Lhab Dorji, President and Dr. Phub Tshering, ENT and Head-Neck Surgeon, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan to render his services as Honorary Consultant surgeon towards treatment of Cranio-Maxillofacial defects and deformities among the Bhutanese people.  

Read moreProf S M Balaji conferred the Craniofacial Research Fellowship Award by the Craniofacial Research Foundation at Paro, Bhutan.

Testimonial – Mr. Taha from UAE is a case of Zygomatico-orbital Fracture

My name is Taha. I am working in the UAE. I have been following Dr. S.M. Balaji since three years. Actually before three years, I met with an accident. I had emergency surgery, but I was never satisfied with the result. I kept on searching every doctor, every possible things I could search for my betterment, but the satisfactory answer I got was in Dr. S.M. Balaji Hospital, Chennai. Sir told me yes brother, your condition will be improved. So I planned everything, I came, and I got operated with Dr. S.M. Balaji. Now my diplopia has been corrected and he did so well that I cannot even see a scar on my face. So really, really, I am so grateful and very thankful to Dr. S.M. Balaji. Thank you sir, thank you very much.

Read moreTestimonial – Mr. Taha from UAE is a case of Zygomatico-orbital Fracture

Dr. S.M. Balaji invited as keynote speaker and moderator to Indian Dental Conference, Bhubaneswar

Invited as Keynote Speaker and Moderator: Dr SM Balaji was invited to the 71st Indian Dental Conference organized by the Indian Dental Association-Odisha State Branch in Bhubaneswar, Odisha to deliver a keynote speech as well as to serve as moderator for a scientific session. The theme of the conference was “Accelerating Innovation and Fostering Advances.” Dr. S.M. Balaji meets the Chief Minister of Odisha The Guest of Honour, the Chief Minister of Odisha, Hon’ble Shri. Navin Patnaik inaugurated the conference at a grand ceremony. Dr. Balaji spoke with the Chief Minister regarding initiatives for increasing awareness about oral health in the state.             Moderator for Scientific Session at the Bhubaneswar Conference: Dr. Balaji and Dr. Suresh Meshram then chaired a scientific session that featured Dr. Sandesh Mayekar, India and Dr. Yong Seok Cho, Korea, Dr. Mayekar spoke about “Functional Smile Designing” and Dr. Cho spoke about “Management of Sinus Membrane Perforation.” Dr. Balaji and Dr. Meshram presented the speakers with Certificates of Appreciation at the end of their sessions. Prof. S.M.Balaji’s Keynote Speech: In his keynote speech at the conference, Dr. Balaji spoke about “Principles and Practice of Vertical Alveolar Ridge Augmentation by Grafting.” Dr. Balaji’s session was chaired by Dr. Satish Bhardwaj and another eminent co-chairman. The moderators for the session presented Dr. Balaji with a Certificate of Appreciation at the end of his keynote speech. A Meeting with Dr. Moule from Australia at the Conference: Dr. S.M. Balaji met with Dr. Alexander Moule of Australia at the conclusion of the conference. Dr. Moule was also a featured keynote speaker at the conference. Dr. Balaji spent some time with Dr. Moule relating the steps being taken to increase awareness about the ill effects of tobacco on the human body in general and the oral cavity in particular among the rural youth in India.

Read moreDr. S.M. Balaji invited as keynote speaker and moderator to Indian Dental Conference, Bhubaneswar

Dr. S.M. Balaji invited as the Chief Guest to deliver the Student Orientation Talk to medical and dental students at SRM Institute of Health Sciences, Kattankulathur

Dr SM Balaji Invited to be the Chief Guest: Prof. S.M. Balaji was invited as Chief Guest to the SRM Institute of Health Sciences, Kattankulathur, by Prof. N. Sethuraman, Registrar, SRM University and Dr. N. Chandra Prabha, Director of Health Sciences, SRM University to deliver an orientation talk to both fresher and senior medical and dental students alike about how to conduct oneself with each other in college. Welcoming the Chief Guest to the SRM Institute of Health Sciences campus: Upon arrival at the SRM Institute of Health Sciences campus, he was warmly welcomed by Prof. N. Vivek, Dean and Head of the Department, Department of Oral and Maxillofacial Surgery, SRM Dental College, Kattankulathur. Upon commencement of the function, Dr. Chandra Prabha greeted Prof. Balaji with a bouquet of flowers and Prof. Sethuraman honored Dr. Balaji with a shawl to mark the occasion. The Student Orientation Talk by Dr SM Balaji: Dr SM Balaji addressed the gathering in his usual lucid and descriptive speaking style, connecting very easily with the audience. He made the audience of predominantly medical and dental students understand how crucial this period of life was to them in germinating the seed that would develop into a career for them. He explained how their behavior in this very crucial stage in life could either make or break their future. He said that the basis of interactions between senior students and the freshers should always be based on respect and wholehearted acceptance, stressing that friendships formed in this period would last a lifetime. He talked about his student days and how much of an impact it has had in making him the success he is today. He humorously related how he met some of his closest friends when they first joined college as his juniors. He added that college days are special in everyone’s life and how college days impact our life well into the future. From the Viewpoint of the Parents of the Students: He then spoke to the students from the point of view of their parents and the difficulties parents undergo in order to ensure that their children have a good education. He said that it was the duty of the students to realize their parents’ dreams for them and to ensure that the sacrifices made by their parents are not wasted. He said that their behavior in college should be exemplary and they should remain focused on academics during the entire period. He congratulated them and said that dentistry as a career choice was a very wise decision and this should be used as a foundation by them to build a good future for themselves. He said that dedication and hard work could make one rise to great heights in this field. He said that they needed to set goals for themselves at this stage of life itself and then work hard on achieving them. He said that indulging oneself in unwanted frivolous activities at this stage could endanger their entire future. Advice to the Students: Prof. Balaji concluded his speech by stating that the students should utilize this very vital period of their lives fruitfully by learning about hard work, perseverance, acceptance of others and ability to remain focused, which are all qualities that would help them do well in life.

Read moreDr. S.M. Balaji invited as the Chief Guest to deliver the Student Orientation Talk to medical and dental students at SRM Institute of Health Sciences, Kattankulathur

Continuing Dental Education program on direct gold restorations with American faculty

Continuing Dental Education program at Balaji Dental and Craniofacial Hospital Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, was the venue of an international continuing dental education program on gold fold restorations on February 25, 2018. The theme of the CDE program was “Back to Golden Times” Direct Gold Foil Restorations- Faculty headed by American expertise: Gold is the world’s oldest filling material, but is labor intensive. The head of faculty conducting the CDE program was Dr. Alfred Wendell Holtz, past president, American Academy of Gold Foil Operators. Dr. Foltz has received many accolades over the course of a distinguished career including the “Commissioned Officer Award for Superior Service” by the USA Public Health Services and the “Clinician of the Year Award” by the American Academy of Gold Foil Operators. The CDE program was held in the hospital’s state-of-art 200-seater conference hall. It was jointly organized by the International College of Dentists-India, Nepal, and Sri Lanka section, Indian Academy of Gold Foil Operators (IAGFO), which is a division of the American Association of Gold Foil Operators, and IDA Madras Branch. Keynote Lectures at the Program: Dr. Foltz delivered the keynote lecture on direct gold foil restorations in the morning session. Other lectures in the morning session included lectures on incorporating gold into clinical practice, pulpal reactions to gold restorations, cast gold restorations, etc. The post lunch session featured table demonstrations of direct gold fillings with many of the participants expressing intent to pursue a career in gold restorations after participating in this hands-on program. All the participants in the program received certificates. Dr. Balaji’s Continuing Passion to Enable Continuing Dental Education Programs: Dr. S. M. Balaji, founder-director of Balaji Dental and Craniofacial Hospital, is a firm supporter of CDE programs and has been instrumental in the hospital playing host to many such CDE programs on a regular basis. He expressed the firm belief that such programs enable both academicians and practicing dentists keep abreast with the latest technical advances being made around the world.

Read moreContinuing Dental Education program on direct gold restorations with American faculty

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