Maxillary Dentigerous Cyst Surgery – Wisdom Tooth Removal
[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=”4.9.2″ _module_preset=”default” hover_enabled=”0″ sticky_enabled=”0″] Patient with gradually increasing left face swelling and pain The patient is a 26-year-old year male from Porto Novo in Tamil Nadu, India. He began noticing the development of pain and swelling in his left upper jaw a few months ago. This has now increased to the point where there is severe pain and discomfort in that region. There is also a feeling of heaviness in that region. Examination at a local dental clinic for diagnosis of his problem He had presented at a local dental clinic where imaging studies had been obtained. This revealed the presence of an impacted molar in the left maxillary sinus. Suspecting this to be a dentigerous cyst, the dentist had immediately referred the patient to our hospital for management. The patient gives a history of undergoing extraction of his left upper second molar a few months ago. Our hospital is a renowned centre for oral and maxillofacial surgery in India. Treatments ranging from simple extractions to complicated craniofacial surgeries are routinely performed at our hospital. Facial trauma surgery and jaw reconstruction surgery are specialty surgeries performed here. Facial cosmetic surgery and cosmetic rhinoplasty are also addressed here at our hospital. Eyelid surgery to address epicanthal folds is also performed in our hospital. We are a super-specialty center for closed rhinoplasty as open rhinoplasty can leave behind residual scars. Initial presentation at our hospital for management of his condition Dr. SM Balaji, Jaw Reconstruction Surgeon, examined the patient. He then ordered for a 3D CT scan and other imaging studies for the patient. This revealed a dentigerous cyst enclosing an impacted third molar in his left maxillary sinus. The condition was explained in detail to the patient and his parents. Treatment planning for enucleation of the cyst along with extraction of the molar and sinus clearance was explained to the patient. The patient and his parents were in complete agreement with the treatment planning and consented to surgery. Ectopic maxillary molar teeth and their implications An ectopic tooth in the maxillary sinus is usually found incidentally on imaging. Dentigerous cysts associated with ectopically erupted maxillary third molars are very rare. Dentigerous cysts are more commonly associated with impacted mandibular third molars. Ectopic eruptions occur when teeth do not erupt in their anatomical positions. These are most commonly seen in the dentate region. Displacement of the tooth to the ectopic site may either be developmental or pathological. Successful enucleation of dentigerous cyst from the maxillary sinus cavity Under general anesthesia, a crevicular incision was made in the left maxillary region. A flap was elevated followed by exposure of the cyst through the Caldwell Luc technique. The dentigerous cyst was removed along with the impacted left third molar. Sinus clearance followed by irrigation was then performed. The incision was then closed with resorbable sutures. Patient expresses his happiness at the results of the surgery The patient and his parents were extremely relieved after the surgery. There was complete resolution of the swelling and discomfort following the procedure. They expressed their satisfaction before final discharge from the hospital. [/et_pb_text][et_pb_video _builder_version=”4.9.2″ _module_preset=”default” src=”https://youtu.be/kqqa64dTwp0″ hover_enabled=”0″ sticky_enabled=”0″][/et_pb_video][/et_pb_column][/et_pb_row][/et_pb_section]
Caldwell Luc Closure of Oroantral Fistula
Patient undergoes traumatic extraction one month ago The patient is a 54-year-old lady from Chennai in Tamil Nadu, India. She had developed pain in the right upper back teeth region around a month ago. An x-ray was taken at an outpatient clinic of a dental school and she had been advised extraction of the right upper second molar. It had been a very difficult extraction and the entire tooth had been removed in pieces. Subsequently, the patient had experienced swelling in the region followed by heaviness on the right side of her face. She described a feeling of having fluid flowing from the right side of her face down her throat. Her family had subsequently made enquiries regarding the best dental hospital in Chennai and were referred to our hospital. Our hospital is a premier oral and maxillofacial surgery center in India. Many patients come to our hospital after unsuccessful surgeries elsewhere. We are renowned for corrective maxillofacial surgery in India. Hundreds of patients with chronic maxillofacial problems have been successfully rehabilitated in our hospital. Initial examination upon presentation at our hospital Dr SM Balaji, Oral and Maxillofacial Surgeon, examined the patient and ordered pertinent imaging studies including a 3D CT scan. The patient stated that she has a history of maxillary sinusitis. Her imaging studies revealed that her maxillary sinus was filled with an exudate. There was also an oroantral fistula present at the site of the traumatic extraction. In addition, a full thickness defect was also noted on the bony nasal septum. The patient had previously undergone a septoplasty approximately three years ago. Nose blowing test was positive. Oroantral communication versus oroantral fistula An oroantral fistula is an abnormal condition where the maxillary sinus is exposed to the oral cavity through an epithelialised fistula. This is a pathologic condition and is not to be confused with oroantral communication. An oroantral communication, if left untreated, can either heal spontaneously or progress into oroantral fistula. The fistulous opening is in a majority of cases situated on the alveolus. Treatment planning explained and consent obtained It was decided to perform an oroantral fistula closure along with clearance of exudates from the maxillary sinus. Caldwell Luc procedure is the ideal surgery for this condition. The surgery was explained in detail to the patient. She then provided consent for the surgery. Surgical closure of the oroantral fistula Under adequate general anesthesia, a crevicular incision was first made in the right maxillary region. A flap was then elevated and the oroantral fistula exposed. There was purulent discharge within the antrum. Through Caldwell Luc technique, a window was created and thorough maxillary sinus clearance was done. Irrigation was done with antibiotics and thoroughly flushed until there was return of clear irrigant. The flap was then reapproximated and sutured using resorbable sutures. Successful resolution of symptoms and antral infection There was no residual fullness felt by the patient. She expressed that all her symptoms had completely resolved and she felt completely fine. The patient expressed her happiness at the results of the surgery and thanked the surgical team before final discharge from the hospital. Surgery Video
Jaw Joint Ankylosis – Lock Jaw Surgery
Patient with inability to open her mouth for many years now The patient is a 10-year-old girl from Rajahmundry in Andhra Pradesh, India. She had extremely limited mouth opening of about 2-3 mm for many years now. This has made it nearly impossible for her to eat any solid food. The patient had been diagnosed with temporomandibular joint ankylosis many years ago. She has been on a liquid diet for a long time and had lost a lot of weight. The patient rarely plays with other children as her speech was also affected. She also exhibited very poor social skills because of her problem. Her parents were greatly worried about her overall health. There was also an anterior open bite. Deciding to get this addressed, they had taken her to a nearby city for consultation. An x-ray at a hospital had revealed that she had ankylosis of her right temporomandibular joint. They had counseled the parents extensively and had referred them to our hospital for management of the patient’s condition. Our hospital is a renowned center for temporomandibular joint ankylosis surgery. Hundreds of patients have been successfully rehabilitated here after lock jaw surgery. Temporomandibular joint reconstruction surgery is also routinely performed in our hospital. Initial presentation at our hospital Dr SM Balaji, jaw reconstruction surgeon, examined the patient and ordered pertinent imaging studies including a 3D CT scan. This revealed that there was complete bony ankylosis of the right temporomandibular joint. The patient also had extremely restricted mouth opening and a retruded mandible. Her parents were not able to recall any trauma that could have led to the ankylosis. It was advised that she has to undergo surgical correction of her ankylosis. The parents consented and the patient was scheduled for surgery. Description of TMJ Ankylosis and its etiology Ankylosis is the condition that causes stiffness in a joint. It can be either fibrous or bony and can affect any joint in the body. When the structures outside the joint are affected, it is termed as false ankylosis. True ankylosis denotes involvement of the structures within the joint. Ankylosis surgery has to be followed by physiotherapy and joint exercises. Night guards can also be advised at this stage of rehabilitation following successful surgical intervention. Children have the shortest recovery time from any form of surgery. Successful surgical correction of her ankylosis The patient underwent general anesthesia through bronchoscopic intubation due to her restricted mouth opening. Once successful anesthesia had been induced, an incision was made in the right submandibular region. This was followed by dissection up to the ankylosed temporomandibular joint. The ankylosed bone was osteotomized and gap arthroplasty was done. Passive mouth opening of about 45-48 mm was obtained following the surgery. Hemostasis was achieved and the incision closed with sutures. Total patient satisfaction at the result of the surgery The patient was instructed to continue with regular physiotherapy consisting of mouth opening exercises and other jaw exercises. Mouth opening was monitored during subsequent follow up visits. The parents were happy with the results of the surgery. They mentioned that she will now be able to eat and speak well without any restrictions. Surgery Video
Successful correction of bilateral cleft lip
[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=” A young baby boy with bilateral cleft lip:” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]A 3-months-old baby boy from Delhi was brought to our hospital seeking treatment for cleft lip and palate. Pre-natal diagnostic scan(USG abdomen) was done and the parents were informed that their baby would be born with a cleft lip at about 3-5 months of age.[/vc_column_text][vu_heading style=”2″ heading=”The search for a renowned cleft lip and palate repair center:” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The parents were well aware that their child would be born with this condition and they started inquiring about the best center for treatment of cleft lip and palate when the baby was in the womb itself. They had searched through the internet and found our hospital to be the best center for cleft lip and palate repair. Their idea of consulting our hospital for cleft lip repair was reinforced when their family doctor also suggested them to seek treatment at Balaji Dental and Craniofacial Hospital. The parents inquired at our hospital about their baby’s condition through a telephonic conversation for which a detailed explanation was given. The do and don’t, methods of feeding and child care were well explained. Furthermore, books on cleft lip and palate were also mailed to the patients for better understanding. [/vc_column_text][vu_heading style=”2″ heading=”Initial visit at our hospital:” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]At about 3 months of age, the child was brought to our hospital. Dr.S.M.Balaji cleft repair specialist examined the baby. The baby had bilateral cleft and palate with an incomplete cleft on the right side and complete cleft on the left side. The parents were advised that the baby has to undergo surgery. They were well aware that the first surgery ( lip repair ) was to be done at 3 months of age followed by palate repair at 9 months.[/vc_column_text][vu_heading style=”2″ heading=”Surgery at 3 months of age:” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The cleft lip repair surgery was done at 3 months of age using Paul Black’s technique. The suture removal was done after a period of 7 days.[/vc_column_text][vu_heading style=”2″ heading=”The outcome of the surgery:” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The result of the surgery was successful. The baby’s appearance improved greatly. His parents were overjoyed to have the defect treated with negligible scar formation. He looked like any other boy of his age after the surgery. The palate surgery will be done 9 months of age followed by alveolar cleft defect reconstruction at 3 and a half years of age.[/vc_column_text][vc_row_inner equal_height=”” animation_delay=”” disable=”” id=”” class=””][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6463″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6464″ img_size=”full” add_caption=”yes”][/vc_column_inner][vc_column_inner vertical_align=”top” animation_delay=”” width=”1/3″][vc_single_image image=”6465″ img_size=”full” add_caption=”yes”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][/vc_section]
Neurofibroma Debulking Surgery for Neck
Patient with progressive development of left lower facial deformity The patient is a 17-year-old female from Mathura in Uttar Pradesh, India. She had been fine up until four years ago enjoying perfectly good health. It was around that time that a slight asymmetry began to develop in her left lower face. This slowly began manifesting as sagging tissue in that region. It progressively worsened and her appearance became altered. Her family stated that she began to lock herself up in her room and refused to come outside. This caused a great deal of distress for her parents. They took her to a neighbouring state for consultation with a doctor. She underwent testing, which revealed her to have plexiform neurofibroma. The condition was discussed in detail with her family members and they were advised surgical correction. Surgery was subsequently performed on her neurofibroma. The patient and her parents were not happy with the results of the surgery. This caused the patient to become depressed about her situation. Her parents too were dismayed at the results of the surgery. This made them conduct enquiries regarding the best hospital for surgical correction of this condition. They were informed that our hospital was the best in cosmetic facial surgery in India. Types of neurofibroma and their manifestations Neurofibromatosis is the condition where there is tumorous growth in the nervous system. This can be differentiated into three types, namely neurofibromatosis type I, neurofibromatosis type II and schwannomatosis. The first variant manifests as light brown spots on the skin. There are also freckles in the armpit and groin, small bumps within the nerves and scoliosis. Type 2 involves hearing loss, cataracts at a young age, balance problems, flesh-colored skin flaps and muscle wasting. The tumors generally do not change into cancerous tumours. Plexiform neurofibromas are larger, more extensive tumors that grow from nerves anywhere in the body. Unlike cutaneous neurofibromas, plexiform neurofibromas are often found in young children. They can even be present at the time of birth. The cause is a genetic mutation that occurs in certain genes. These can be inherited from a person’s parents or can occur spontaneously during early development. These tumors involve supporting cells in the nervous system rather than the neurons. There is no known prevention or cure. Surgical removal is the only remedy for these tumors when they begin causing problems or become cancerous. Tumor suppressants are not effective in treating this condition. Reconstructive surgery offers adequate cosmetic results for these patients. Initial presentation at our hospital for neurofibromatosis treatment Dr SM Balaji, neurofibroma correction specialist, examined the patient and obtained a detailed oral history. He then ordered 3D CT scan and other radiological studies for the patient. Clinical examination revealed that her left lower face was sagging downwards. There were Café au Lait spots all over her body. The left ear lobule was also involved by the growth. Presurgical counseling was provided to the patient and her parents. It was explained that the excess tissue had to be surgically excised through a submandibular approach. Extreme care would be taken while planning surgery to ensure that there was no facial disfigurement caused by the surgery. Successful correction of facial disfigurement following surgery Under general anesthesia, an incision was made in the submandibular region overlying the growth. Excess neurofibromatous tissue was excised and the incision was closed with sutures. Outcome of the surgery: The patient and her family were very happy with the outcome of the surgery. They expressed their thankfulness before final discharge from the hospital. Surgery Video
Redo Rhinoplasty – Removal of Mobile Silastic Graft
Patient with a history of cleft lip, palate and alveolus surgery The patient is a 22-year-old female from Kanpur in Uttar Pradesh, India. She was born with a cleft lip and palate deformity. Doctors had counseled her parents about what to expect with cleft children. They had also presented them with a schedule for surgical correction of her deformities. Past history of surgical correction of her cleft deformities She had undergone cleft lip surgery at 3 months of age and cleft palate surgery at 8 months old. Cleft alveolus surgery had been performed at 4 years of age. All these surgeries were performed in a neighboring state at the same hospital. Her parents had been satisfied with the results of the surgery. The hole in the roof of the mouth had been completely closed and the patient had no feeding or speech problems. However, as the patient grew up, her nasal deformity had gradually worsened. Her nostrils were asymmetrical and she had a collapsed bridge of the nose. She had a saddle nose deformity with gross nasal asymmetry caused by a depressed left nostril. This caused her to become depressed and they decided to get this addressed at a nearby city. Failed primary rhinoplasty with mobile silastic graft She underwent a primary rhinoplasty about two years ago for correction of her nasal deformities. This had been performed utilizing a silastic graft to lift up the dorsum of her nose. Nasal tip had also been enhanced by the surgery. All deformities of the nose involve components of bone and cartilage. The graft however never stabilized and remained mobile. This has made the patient very self conscious and withdrawn. It finally reached the point where she decided to get this addressed. The patient and her parents made extensive enquiries regarding the best rhinoplasty hospital in India. They were repeatedly informed that we were the best hospital in India or rhinoplasty correction. She discussed this extensively with her parents and they decided to come to our hospital for her surgery. The best rhinoplasty surgeons in India come to our hospital for regular workshops. India is a top destination for medical tourism from around the world. Nose reshaping through cosmetic surgery is one of the most commonly desired procedures by such patients. The cost in India is also just a fraction of what it costs in the developed countries. Surgical results though are on par with the results obtained in the Western world. Initial visit for consultation and treatment planning at our hospital Dr SM Balaji, cosmetic rhinoplasty surgeon, examined the patient and obtained a detailed history from her parents. He also ordered pertinent imaging studies including a 3D CT scan. The patient said that the graft on her nasal dorsum was mobile. This caused her to become extremely self conscious. She had also begun to withdraw socially because of this. Examination of her nose revealed an extremely mobile nasal bridge. This was the result of the infected silastic nasal graft. There was a depression of the left side of the nose from the cleft lip deformity. The left nostril was also considerably smaller in size along with a noticeable depression in the left anterior maxillary region. Rationale behind treatment planning explained to patient and parents It was explained that the silastic graft needed to be removed. A costochondral graft would be utilized for nose correction. The grafts would be harvested from the patient at the beginning of the surgery. Successful surgical correction of maxillary depression and nasal deformity Under adequate general anesthesia, an incision was made in the right inframammary region. A costochondral rib graft was harvested. Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The wound was then closed in layers with sutures. A transcartilagenous incision was made in the right nostril. This was followed by dissection and removal of the infected silastic graft. The nasal dorsum was then augmented using the costochondral graft along with a strut graft to elevate the left nostril. Patient expresses happiness at the results of the surgery The patient was extremely happy with the results of the surgery. Her nose now had a more symmetrical and prominent profile. It was in complete harmony with her face with equal nostril size. She said that this would help her gain more self confidence and participate in social events without feeling self conscious. Surgery Video
TM Joint Ankylosis (Fibrous) with total coronoid fusion
Inability to fully open mouth for many years now The patient is a 55-year-old female from Agartala in Tripura, India. She relates having restricted mouth opening for a very, very long time. History also includes a distant vague memory of trauma to the chin when she was a little girl. She recalls parents saying that they had not visited a dentist at the time of the trauma. Progressive reduction of mouth opening with resultant functional difficulties The patient stated that she has always had difficulty eating due to restricted mouth opening. Over the past few years, the jaw joint trismus had become progressively worse. She is now completely unable to move her mandible. The patient has started having panic attacks due to the increasing difficulty with eating and speech. It was difficult for her to eat or drink. Her family decided that this needed to be addressed and had sought consultation at a local hospital. She had undergone a barium swallow test there, which revealed that the patient had a very narrow pharynx. It was unclear if the narrowing of her food pipe was recent. The patient needed corrective jaw surgery. Referral by outside facility to our hospital for treatment They advised them that the inability to move the lower jaw needed to be addressed immediately. It was explained that she had temporomandibular joint ankylosis. They had advised them that this needed to be surgically corrected and had referred them to our hospital for management. Our hospital is a premier center for TMJ ankylosis surgery in India. Temporomandibular joint surgeries are regularly performed in our hospital. Many patients have been successfully rehabilitated through jaw reconstruction surgery. Condyle reconstruction surgery is a specialty offering at our hospital. Mandibular reconstruction surgery through bone grafts is also available at our hospital. Surgery using bone flaps are also performed in our hospital. Iliac bone graft surgeries are also performed in our hospital with the ilium being the donor site. Initial presentation at our hospital for management of the ankylosis Dr SM Balaji, TMJ ankylosis surgeon, examined the patient and obtained a detailed oral history. He then ordered comprehensive imaging studies for the patient including a 3D CT scan. Clinical examination revealed that she had inability to move her mandible with a mouth opening of 10 mm. Her family related that her mouth opening has significantly reduced over the last two years. Examination of her barium swallow study revealed that she had a narrowed pharynx. She also had very poor oral hygiene. There was halitosis and plaque buildup in her oral cavity. Her speech was also difficulty to understand. Her 3DCT scan revealed bilateral TMJ fibrous ankylosis between the mandibular condyle and glenoid fossa. The recently inability to move her mandible was due to bilateral coronoid fusion. Treatment planning formulated and surgical consent obtained from patient In view of the patient’s extremely limited mouth opening, it was advised that the patient undergo bronchoscopic intubation for anesthesia. This would be followed by releasing the fibrous ankylosis in her bilateral temporomandibular joint along with bilateral coronoidectomy. This would correct her mouth opening difficulty. Treatment rationale was explained to the patient and her parents in detail and they consented for surgery. Surgical correction of the bilateral fibrous ankylosis of the TMJ Bronchoscopic intubation was performed because of the patient’s extremely reduced mouth opening. Following successful induction of general anesthesia, attention was turned to release of the patient’s fibrous ankylosis. Incisions were first made in the mandibular retromolar region bilaterally. A flap was then elevated and the fibrous ankylosis identified. This was released followed by bilateral coronoidectomy. Passive mouth opening of up to 50 mm was achieved following the surgery. Pterygoid muscle and masseter muscle function was normal. Successful surgical outcome with increased mouth opening Hemostasis was achieved and closure done using resorbable sutures. Suction drain was also placed to prevent an accumulation of exudates or blood postoperatively. The patient was then extubated and brought to the recovery room in stable condition. Total patient satisfaction with the results of the surgery A mouth opening of about 50 mm was achieved through the surgery. Physiotherapy was started with jaw exercises under supervision after a period of about one week following surgery. Physiotherapy is imperative to prevent relapse of her condition. This would be performed along with mouth opening exercises at subsequent visits. She and her parents expressed complete understanding of the instructions. They expressed how this surgery would completely transform her life. She would now be able to participate in all social interactions and lead a completely normal life. Surgery Video
Alveolar Bone Graft Surgery for Dental Implant
Patient involved in a road traffic accident in his hometown The patient is a 24-year-old steel worker from Bokaro steel city in Jharkand, India. He was riding to work on his motorcycle around two years ago when he was involved in a road traffic accident. The patient was an unhelmeted rider at the time of the accident. Impact from the accident had led to avulsion of his upper central incisors as well as right lateral incisor. He had been taken to a nearby local hospital where first aid had been provided and wounds cleaned and debrided with antiseptic solution. Bone growth has been completed in the patient as he is 24 years old. There were no broken bones from the accident. A visit to a local dental clinic, a month later had resulted in the patient obtaining removable dentures for the missing teeth. He had found them to be esthetically acceptable, but functionally inadequate. Prolonged use of the removable dentures had led to bone loss at the site of the avulsion. Decision to undergo rehabilitation with dental implants A friend had recommended that he undergo dental implant surgery for permanent rehabilitation of his missing teeth. He had visited a nearby dentist who examined him. Realizing that the patient would need bone grafting for dental implants, he had referred the patient to our hospital. Our hospital is renowned for dental implant surgery in India. All-on-4 implants, zygoma implants and single implants are all available at our hospital. We also have an in house dental laboratory for fabrication of quality ceramic crowns, porcelain crowns or zirconia crowns or bridges. Monolithic zirconia bridges are a specialty at our hospital. Bone graft surgery for dental implant placement is a common case which is done here. There are scores of patients being rehabilitated at our hospital. Patient presents at our hospital for rehabilitation of his missing teeth Dr SM Balaji, dental implant surgeon, examined the patient and ordered imaging studies. Imaging studies revealed that the patient lacked adequate bony support for placement of implants. After conducting various studies, it was decided to harvest bone from the region of the lower molar teeth to be used as a graft. It was explained that this would help consolidate bone in the region of the missing anterior teeth. The harvesting process was also explained in detail to the patient. He expressed understanding of the treatment plan and consented to dental implant surgery. The best bone graft material is always autologous bone graft. Successful placement of dental implant and bone graft Under general anesthesia, a bone graft was first harvested from the mandibular third molar region. This was followed by placement of two Nobel Biocare dental implants in the patient’s anterior maxilla. This was followed by shaping and placement of the grafts in the region of bone deficiency. The bone graft pieces were fixed in placed using titanium screws. This was followed by suturing of the flaps. Postoperative instructions to the patient The patient was instructed to present back at the hospital in three months for fabrication of crowns. This period would enable complete osseointegration of the dental implants with the surrounding bones and consolidation of the grafts. The patient expressed understanding of the instructions and thanked the surgical team. Surgery Video
Cosmetic Rhinoplasty – Bulky Nose Reduction Surgery
Young man with a strong dislike for his nose The patient is a 19-year-old male from Wandiwash in Tamil Nadu, India. He had developed a strong dislike for the shape of his nose since very young. The appearance of his nose had resulted in a bit of bullying during his school days. There have however never been any breathing and feeding difficulties. He had always wished to have a narrower and sharper nose. The form of his nose, he felt, was very broad for his face. It appeared very bulky. There were no deformities involving the roof of the mouth or the nasopharyngeal airway. The only complaint that the patient had was with the shape of his nose. Seeing the degree of unhappiness the patient had over his nose, a friend had suggested that he undergo cosmetic nose surgery. He also said that the patient needed to visit a facial plastic surgeon. The patient also like the idea of a nose job and convinced his parents about it. After making enquiries about the best hospital for the procedure, they decided to come to our hospital for consultation. Our hospital rigorously follows surgical protocols laid down by the American Association of Plastic Surgeons. Initial examination upon presentation at our hospital Dr SM Balaji, Cosmetic Rhinoplasty Specialist, examined the patient. He ordered for comprehensive imaging studies. Clinical evaluation revealed a bulky nose without a prominent tip. There was also excess soft tissue over the nasal bridge, thereby causing the nose to appear shapeless. Treatment planning was explained to the patient in detail. Excess soft tissue would be removed to reduce the nasal bulk first. This would be followed by augmentation of the nasal dorsum using a costochondral graft that had been harvested from the patient. Our hospital is renowned for cosmetic rhinoplasty in India. Both bone and cartilage contribute to the shape of the nose. Open rhinoplasty can lead to visible scars while no visible scars will result from a closed rhinoplasty. This aspect of the surgery was very appealing to the patient. The patient was in agreement with the treatment plan and consented to surgery. Types of shapes of the nose Nasal shapes vary according to the structure of the underlying bone and cartilage. Nasal shapes have been classified under aquiline, broad and flat. Aquiline is found in the Caucasians, flat in the mongoloids and varying degrees of broad in the rest. Nasal deformities can appear in the form of crooked nose deformity, saddle nose deformity, dorsal hump, parrot beak deformity and hooked nose deformity. Certain conditions such as Pierre-Robin syndrome manifest a hooked nose. Cosmetic rhinoplasty is the surgery of choice for correction of these nasal deformities. Successful surgical correction of the bulky nose deformity Under general anesthesia, a right inframammary incision was made followed by harvesting a costochondral graft. A Valsalva maneuver was next performed to ensure patency of the thoracic cavity. The incision was then sutured close in layers. Attention was next turned to the nose. A transcartilagenous incision was first placed in the right nostril and dissection was done up to the nasal dorsum. Excessive soft tissue was identified and excised. This was followed by augmentation of the nasal dorsum using the costochondral graft. Closure of the wound was then done using resorbable sutures. The patient was extubated and brought to the recovery room in stable condition. Total patient satisfaction with the results of the surgical procedure The patient and his parents were very happy with the results of the surgery. He liked his new nose immensely. His nose was now narrower, more symmetrical and had an elevated dorsum. He expressed that he would now be able to face life with a greater degree of confidence. Surgery Video
Facial Neurofibroma Debulking Surgery
Gradual development of facial deformity since young The patient is a 19-year-old boy from Karaikudi in Tamil Nadu, India. His parents first noticed the development of a facial deformity when he was around 4-5 years old. This had slowly progressed to the point where there was gross deformity of the right side of his face. He had slowly lost confidence with the passage of time and became depressed because of this. They had presented to a local surgeon when he was 14 years of age. A detailed history was obtained from the patient and he was subsequently diagnosed with neurofibromatosis of the right side of the face with a sagging lip. Difficulties arising from the long standing neurofibromatosis The excessive growth has caused a great deal of hardship for the patient, resulting in difficulty with eating and speech. The patient had already lost his right eye sight due to this condition. Having confirmed the diagnosis of neurofibromatosis, the surgeon had advised to remove the excessive tissue surgically. The patient and his parents had consented to surgery and the patient underwent surgery. However, the overgrowth recurred shortly and worsened considerably over the years. It has now reached the point where it has become a hindrance to the patient’s activities of daily living. They then made extensive inquiries regarding the best hospital to address this problem and had been referred to us. Patient and his parents presented at our hospital Dr SM Balaji, neurofibroma surgeon examined the patient and ordered for imaging studies including a 3D CT scan. Examination revealed that tumor grown was extensive and had caused the right side of his face to sag downwards. The right lateral border of the lip was also sagging downwards. His eye was also infected and appeared larger in size. There were also numerous Café au lait spots seen all over the patient’s body. The patient manifested all the signs and symptoms of neurofibromatosis. Premier treatment center for facial deformity surgery Our hospital is a premier center for facial deformity surgery in India. Both soft tissue deformities and bony deformities are addressed at our hospital. Many patients with debilitating facial deformities have undergone surgery at our hospital, helping them to lead relatively normal lives. Dr SM Balaji has extensive experience of over 25 years as a cosmetic surgeon and this facet has immensely helped to rehabilitate patients with gross facial deformities. Many patients have had their lives restored to complete normalcy after undergoing cosmetic facial surgery at our hospital. Etiology and pathogenesis of neurofibromatosis The patient has been diagnosed with plexiform neurofibromatosis. This condition causes tumors to develop in the nervous system. It can be subdivided into neurofibromatosis type I (NF1), neurofibromatosis type II (NF2) and schwannomatosis. The first is manifested as light brown spots on the skin along with freckles in the armpit and groin. There are also small bumps within the nerves and scoliosis. Second is manifested by hearing loss, cataracts at a young age and balance problems. There are also flesh-colored skin flaps and muscle wasting. Plexiform neurofibroma are larger, more extensive tumors that grow from nerves anywhere in the body. Unlike cutaneous neurofibroma, plexiform neurofibroma are often found in young children. They can even manifest around the time of birth. This condition is caused by a genetic mutation in certain genes. They can be inherited from parents or can develop spontaneously during early development. The tumors affect the supporting cells of the nervous system and not the neurons. It is very rare that cancerous tumors arise from this condition and only an extremely small percentage of the general population is afflicted by this condition. There is no known prevention or cure. Surgery may be done to remove tumors that are causing esthetic problems or have turned cancerous. Treatment planning explained to patient and parents in detail The surgical procedure was explained in detail to the patient and his parents. It was explained that the overgrowth of his plexiform neurofibroma would be excised. Excision was planned very carefully keeping in mind not to cause permanent facial disfigurement. The patient and his parents gave their consent for the surgery. Surgical excision of neurofibromatosis growth An elliptical incision was made on the right side of the face and excess neurofibroma tissue was excised. A Weir excision was also done on the right nostril to create symmetry of the nose. Lip level was also adjusted and all incisions were closed with non resorbable sutures. Successful surgical outcome of the surgery The patient and his parents expressed their happiness to Dr SM Balaji. An immediate result of the surgery was the improved ability to eat and easier speech. His facial profile was also greatly improved and they were happy with the outcome of the surgery. Surgery Video