Reversing the Smile: Transforming Lives Through Unilateral Cleft Lip and Palate Closure at Dr. S.M. Balaji
This adorable young boy was born with a significant unilateral cleft lip and palate deformity. His parents, understandably concerned about their child’s well-being, sought expert guidance at Dr. S.M. Balaji’s renowned hospital. A Journey of Hope and Healing At the tender age of 3 and a half months, the little boy underwent cleft lip surgery. Dr. Balaji employed a meticulous technique, first raising a C-flap to reconstruct the nasal floor and sill. With utmost precision, the cleft lip was carefully reapproximated using a three-layer closure, ensuring perfect alignment of the orbicularis oris, subcutaneous tissue, and skin under the magnification of a surgical loupe. Restoring Function and Enhancing Aesthetics Ten months later, the boy underwent cleft palate closure. Guided by Delaire’s principle, Dr. Balaji detached the abnormal attachments of the levator palati and tensor palati muscles, forming a hammock with the muscle fibers. This meticulous procedure allowed for the recreation of a normal palatal structure. The surgery concluded with a positive suction test, confirming optimal closure of the cleft palate defect. The boy’s deformities were effectively corrected, resulting in both aesthetic and functional improvement. His speech development was also positively impacted, as observed during a follow-up visit at our hospital. A testament to Dr. Balaji’s Expertise This case exemplifies Dr. S.M. Balaji‘s exceptional skill and dedication to restoring smiles and transforming lives. His expertise in cleft lip and palate surgery has brought hope and healing to countless children, empowering them to embrace their true potential. Dr. S.M. Balaji: A Beacon of Hope for Children with Cleft Lip and Palate If your child is facing a cleft lip and palate deformity, Dr. S.M. Balaji offers a beacon of hope. With his unparalleled expertise and compassionate care, he can provide your child with the transformative treatment they deserve. Schedule a consultation today and embark on a journey of healing and transformation.
Unilateral Cleft Lip and Palate Deformity
This little boy was born with a unilateral cleft lip and palate. His parents had been very distressed by his facial deformity. They were referred to our hospital for cleft lip surgery when he was 3 months of age.
Modified Millard Unilateral Cleft Lip Repair Surgery
[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” 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=”Patient born with a unilateral cleft lip, palate and alveolus deformity” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The patient is a 3-month-old female infant from Ajmer in Rajasthan, India. She was born with a left-sided cleft lip, palate and alveolus deformity. Her upper lip was split because of the cleft lip. There was a communication between the oral and nasal cavities through the roof of the mouth. This had devastated the parents. Cleft defects are the most common form of birth defects affecting newborns. Hospital staff had provided extensive counseling for the family and educated them about the condition. Parents were most distressed by her feeding difficulties. Friends had informed them that they needed to approach a facial plastic surgeon.[/vc_column_text][vu_heading style=”2″ heading=”Contact with parents of another child who had undergone cleft deformity repair previously” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]The hospital had referred the parents to the parents of another child who had been born with cleft deformity a few years ago. Parents immediately got in touch with them. They also met the child who had been born with a cleft defect. The child was now 6 years old and appeared normal with completely normal speech. The parents were informed that Dr SM Balaji had operated on their daughter. They also informed that this surgery had been a little over five years ago. All their fears regarding the deformity affecting their child had been allayed over the years following cleft surgery. They said that their daughter had not faced any problems because of her cleft defect. Parents immediately obtained contact information about our hospital and got in touch with our hospital manager. They had then been given an appointment to meet Dr SM Balaji for a consultation.[/vc_column_text][vu_heading style=”2″ heading=”Center of excellence for cleft lip repair in the entire Southeast Asian region” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Our hospital is a premier cleft lip surgery hospital in India. We are recognized as a center of excellence for cleft lip surgery by the International Cleft Lip and Palate Foundation (ICPF) of Japan. We are the proud recipients of the prestigious ‘Prof David Precious Award.’ This was awarded in recognition of innovations developed by us for the rehabilitation of cleft patients. We are also an affiliate of the Dallas-based World Craniofacial Foundation (WCF).[/vc_column_text][/vc_column][/vc_row][vc_row content_layout=”boxed” animation_delay=”” disable=”” id=”” class=”” bg_type=”image” bg_image=”” color_overlay=”” enable_parallax=”” enable_pattern=””][vc_column width=”1/2″ layout=”normal” vertical_align=”top” animation_delay=””][vc_single_image image=”6926″ img_size=”full” add_caption=”yes”][/vc_column][vc_column width=”1/2″ layout=”normal” vertical_align=”top” animation_delay=””][vc_single_image image=”6927″ img_size=”full” add_caption=”yes”][/vc_column][/vc_row][vc_row content_layout=”boxed” 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=”Initial presentation at our hospital for rehabilitation of her cleft lip defect” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Dr SM Balaji, cleft repair surgeon, examined the patient. The patient had buckling of the columellar cartilage. There was a widened alar base defect and the floor of the nose was nonexistent. The nasal sill was also absent on the left side. There was also a cleft alveolus defect. It was explained to them that modern surgical intervention would leave minimal discernable scars depending upon the skin condition. They were reassured that the patient would lead a completely normal life. The surgical schedule was explained to them in detail. Importance of adhering to the timetable was explained to them.[/vc_column_text][vu_heading style=”2″ heading=”Correct time schedule for performing each step of cleft deformity repair” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]They were informed that cleft lip surgery needed to be done at 3 months of age. This would be followed by cleft palate surgery at 8-10 months of age. Cleft alveolus repair may be needed between 4-5 years of age. This will be performed with rh-BMP if there is a large alveolar defect. Pharyngoplasty may also be required if the patient develops speech problems. Speech therapy would also be needed in case of issues with speech. Meticulous treatment planning was performed for the patient. Thorough biometric studies were ordered and a projection of growth was predicted for the reconstruction and surrounding structures. A modified Millard’s cleft lip surgery would be performed for repair of the patient’s cleft lip. This planning protocol would ensure the best possible symmetric and functional repair for the patient. Parents expressed understanding and consented to surgery.[/vc_column_text][vu_heading style=”2″ heading=”Successful repair and reconstruction of unilateral lip and nasal deformities” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]Under general anesthesia, an incision was made along the philtrum and dissected down to the subcutaneous tissues. Attention was first turned to the nasal floor defect. This was then reconstructed. A C-flap was raised for recreation of the nasal sill. A surgical loupe was used to visualize the surgical site during the entire procedure. It was decided to utilize a three-layer closure of skin, subcutaneous tissue and muscle to obtain the best possible esthetic results. There was good recreation of the vermillion, philtral column and orbicularis oris. Nasal floor recreation resulted in raising of the alar base. Fine 4-0 Vicryl sutures were utilized for closure of the cleft defect.[/vc_column_text][vu_heading style=”2″ heading=”Successful postoperative healing of cleft defect with optimal results” subheading=”” alignment=”left” custom_colors=”” class=””][vc_column_text]By the seventh day following surgery, there was just minimal scarring at the site of the surgical repair. The patient had developed a good suckling reflex following surgery and began to feed well, gaining weight. Establishment of symmetry of the lips results in pleasing facial esthetics. Parents were very happy with the results. It was explained to the parents that this was just the first step in the long road to rehabilitation for the patient. They expressed complete understanding of this and were committed to sticking to the surgical schedule that had been provided to them.[/vc_column_text][vc_video link=”https://youtu.be/3ozYKROb4vQ” title=”Surgery Video”][/vc_column][/vc_row][/vc_section]
Unilateral Cleft Deformity – Le Fort I Upper Jaw Advancement
The patient is a 19-year-old male from Thanjavur in Tamil Nadu, India. The product of a consanguineous marriage, he was born with a unilateral cleft lip, palate and alveolus deformity.
Jaw symphyseal bone grafting surgery for dental implant
Patient with a history of unilateral cleft lip and palate repair The patient is a 22-year-old from Dehradun in Himachal Pradesh, India who was born with a left sided unilateral cleft lip and palate. Lower facial growth is at times affected on the side of the cleft. Speech development is also affected if there is velopharyngeal incompetence. This is characterized by the presence of a hole in the roof of the mouth that creates a direct communication between the oral and nasal cavity. Speech therapy is needed after completion of the surgical phase of rehabilitation for complete normalization of speech. Surgical repair of his cleft lip defect had been performed when he was 4 months old. This was performed at a local hospital. He had later undergone cleft palate repair when he was 10 months old. Cleft lip repair is ideally performed at 4 months of age and cleft palate repair is ideally performed at 10 months of age. He had later undergone alveolar cleft reconstruction at the age of 3-1/2 years. His teeth however erupted in a malaligned fashion due to his cleft defects. He had undergone fixed orthodontic correction of his malaligned teeth at the age of 12 years. His left lateral incisor was however congenitally missing due to the location of the cleft in the region of the left lateral incisor. It had been advised to his parents that placement of a dental implant at that site would complete the rehabilitation process for him. He had undergone bone grafting with iliac crest to facilitate placement of the implant but there had been failure of the graft. A second bone graft surgery was attempted, but that too resulted in failure of the graft. He had been very disappointed by this and had settled for a removable denture to replace his missing left lateral incisor. Referral to our hospital for bone graft surgery and dental implant placement The patient had sought consultation at a few dental hospital regarding bone graft surgery, but they had expressed their inability to perform that surgery. It was then that an oral surgeon in Nainital had informed the patient that this procedure could be performed successfully at a specialty cleft lip and palate repair hospital and had referred the patient to our hospital for treatment Initial examination and treatment planning at our hospital Upon arrival at our hospital, Dr SM Balaji, cleft lip surgery and cleft palate surgery specialist, examined the patient and obtained a detailed oral history. A 3D CT scan was obtained to study the region of the bony cleft in detail. This revealed deficient alveolar bone in the region of the left lateral incisor. The patient also had malocclusion of his teeth despite undergoing fixed orthodontic treatment elsewhere. It was explained to the patient and his parents that he first needed to undergo fixed orthodontic treatment first so that sufficient space could be created for placement of the implant. This would be followed by bone graft placement at the site of the bony deficiency to enable placement of the dental implant. This bone graft would be harvested from the mandibular symphyseal region as the previous grafts from the iliac crest and rib region had been rejected. The patient and his parents were in agreement with this treatment plan and the patient began fixed orthodontic treatment. Sufficient space was created after six months of treatment for placement of the implant and the patient is now ready for bone graft placement. Successful placement of bone graft in the maxillary bone Under general anesthesia, a crevicular incision was made in the anterior mandible and a flap was elevated to expose the symphyseal bone. Bone cuts were made in the region and a strip of buccal cortical bone was harvested from the region. Following this, a midcrestal incision was placed in the maxilla in the region of the left upper lateral incisor and a flap was elevated. The area of the bone defect was then exposed and reconstructed using the bone graft, which was fixed in place using titanium screws. Closure of the incision was done using resorbable sutures. Implant surgery planning The graft was perfectly placed in the region of the bony defect in the maxilla. A period of three to four months would be allowed for the graft to successfully blend in with the maxillary bone following which dental implant surgery would be performed. A further period of six months would be allowed for complete osseointegration of the implant with the bone following which a crown will be placed on the implant to complete rehabilitation of the patient. A crown is an artificial tooth that is fabricated to mimic a natural tooth and is fixed on top of the implant. These artificial teeth are fabricated from ceramics or zirconium. Implant surgery can also be performed under local anesthesia in cases without any complications. The patient and his parents were extremely happy with the results of the surgery and were instructed to report back to the hospital in three to four months for dental implant surgery. Surgery Video
Simultaneous Unilateral Cleft Lip and Palate Repair
Baby boy from Assam This baby boy from Assam was born with a cleft. He is about one year of age. The incidence of cleft lip and palate in newborns is comparatively higher in Assam. The baby had a split upper lip. He also had a hole in the roof of his mouth which affected his feeding. An ultrasound test during development in the womb revealed that the developing baby had a cleft. There is a history of clefts running through the family. Even though the parents were aware of the right time to perform the surgery, they were hesitant and brought the baby only at about one year of age. They, however, requested for simultaneous cleft lip and palate correction. Unilateral cleft lip and palate Unilateral cleft lip is a congenital split in the upper lip on one side. It is often associated with cleft palate. The cleft palate refers to a hole in the roof of the mouth. It usually involves the soft palate and hard palate. Babies with cleft lip and palate have difficulty in feeding. They have nasal regurgitation. Cleft babies may develop various problems as they continue to grow. They develop dental problems which require corrective treatments. The dental problems may require surgical and non-surgical intervention. They also have an increased risk of middle ear infections which may lead to hearing problems. Babies born with clefts may have speech problems. Thereby requiring a speech therapist opinion. Types of clefting There are various types of clefting which may involve oral and nasal cavities. They are Incomplete Unilateral and Bilateral Cleft lip and palate surgery in India The parents were very depressed with their baby’s condition. They were very concerned about her future. They were searching through the internet for the best cleft lip surgeon in India. They were referred to our hospital by a local physician. Dr.S.M.Balaji one of the leading cleft lip and palate surgeon in India examined the patient. He agreed to correct the cleft lip and palate simultaneously. The oral and nasal cavities had to be closed also. Cleft palate repair Cleft palate repair was to be done first. The abnormal palatal musculature was to be corrected during the surgery. The cleft palate repair was done using Veau Wardill Kilner’s technique. Primary cleft lip repair Corrective lip repair was also of utmost importance. Cleft lip and palate surgeon Dr. S.M. Balaji also performed cleft palate repair at one year of age. Unilateral cleft lip repair is done using Modified Millard’s technique. The upper lip musculature was also corrected during the surgery. Surgery outcome: The result of the surgery was as expected. He looked normal unlike any other child of his age with minimal to no scar. The parents were pleased with the outcome of the surgery. Future surgical corrections: Bone grafting is to be done at 3 and a half to 4 months of age thereby promoting bone growth. Speech correction / Pharyngoplasty may be necessary at 3-4 years of age. Further surgical corrections will be carried out at later date.
Primary lip repair for unilateral cleft lip & palate
This is a 3-month old baby girl from Jammu. She was born with a unilateral cleft lip & palate. Her parents brought her to our hospital for treatment. An Internet search pointed to our hospital as being the best center for cleft repair. Maxillofacial Surgeon Dr. SM Balaji examined the patient. He performed the primary cleft lip repair surgery using Modified Millard’s technique. Following surgery, the baby’s appearance became normal. The parents were very happy with the results as she hardly had any post-surgical scars. Cleft palate correction surgery will be at a later date.
Primary lip repair for unilateral cleft lip and palate
Baby girl with unilateral cleft lip and palate presents for surgery This is a 3-month old baby girl from Guwahati born with a unilateral cleft lip and palate. Her parents were very disturbed over this. They decided to search the Internet for the best cleft lip and palate repair surgeon. This brought them straight to our hospital seeking treatment for her cleft deformity. They expressed their anxieties over their daughter’s condition. Patient examined and surgical plan presented to parents Cleft lip and palate repair specialist Dr SM Balaji examined the patient. His decision was to perform the modified Millard’s technique. The parents were in complete agreement with his treatment plan. Successful surgical correction of cleft lip Surgery for the little girl was a resounding success. Following surgery, 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 correction surgery will be at a later date.
Single sitting simultaneous unilateral cleft palate and lip repair
A boy from Ladakh with unilateral cleft lip and palate The patient is a 10-month-old boy with unilateral cleft lip and palate deformity. He lives with his parents in Leh. His family is from a pastoral background. A Good Samaritan from Delhi happened on this little boy during a trek in Ladakh. He offered to help the child and the parents accepted his help. The Good Samaritan did extensive Internet research. This was to find the best cleft lip and palate surgeon who could perform a total cleft repair in one sitting. His search led him straight to our hospital. Treatment planning for simultaneous cleft lip and palate repair Dr SM Balaji examined the patient and ordered imaging studies. He explained to the parents that both cleft lip and repair would undergo surgery. He undertook the surgery after detailed presurgical planning. Simultaneous cleft lip and palate repair surgery performed Under general anesthesia, cleft palate repair was first undertaken. Bilateral palatal flaps were first raised based on the greater palatine vessels. The Levator palatine muscles were then detached from their abnormal positions. These were then reattached into normal position like a hammock. A two layer closure was then done. The nasal floor was first closed in a separate layer with the vomerine flap making a reverse knot. Oral layer was then sutured by vertical mattress sutures. The vertical mattress sutures produce a ridge of thick mucoperiosteum. Flaps were then approximated to each other in the midline. This technique repositions the levator muscle in a more favorable position. Greater palatine osteotomy was then done to mobilize the artery. This was from the greater palatine canal. The suction test performed at the end showed good results. Unilateral cleft lip repair was then performed with the modified Millard’s technique. This resulted in a very good lip seal producing good esthetic results. Parents satisfied with very good surgical results The parents expressed their immense gratitude before discharge from the hospital. Surgery Video
Upper jaw Advancement Surgery Unilateral Cleft Hypoplasia – Lefort 1 Advancement Surgery
Patient presents for maxillary advancement surgery This young lady had been born with a unilateral cleft lip and palate. She had undergone cleft lip repair at our hospital at the age of 2 months. Cleft palate repair was later performed at the age of 10 months. After this, she had rhBMP-2 surgery for uniting the two pieces of the maxilla into one single bone. The patient now has a hypoplastic retruded maxilla with anterior crossbite. This had been causing her cosmetic problems with a deficient upper jaw. She wanted to have this corrected through surgery. The patient has also been undergoing fixed orthodontic treatment for cosmetic teeth alignment. Le Fort 1 maxillary osteotomy planned for the patient Dr SM Balaji is a renowned cleft lip and palate patient rehabilitation specialist. He decided to perform a LeFort 1 osteotomy with maxillary advancement for the patient. Complete correction of the patient’s crossbite occlusion Under general anesthesia, a mucogingivoperiosteal flap was first raised in the maxilla. A LeFort 1 osteotomy was then performed. The maxillary bone was then advanced by 2 cm. It was then stabilized in place with four L-shaped four-holed plates. Occlusion was then checked and deemed to be in perfect alignment. The mucogingivoperiosteal flap was then sutured back in place. She would need further fixed orthodontic treatment to perfect her teeth alignment. Postoperative period was uneventful. The patient expressed her happiness at the results of the surgery before discharge.