Parry Romberg’s Nose Lip and Chin Asymmetry Correction with Reduction Rhinoplasty
Mechanism of Parry Romberg syndrome explained Parry Romberg syndrome is a rare neurocutaneous syndrome of unknown origin. It causes progressive hemifacial atrophy. This is often sporadic in its course. It leads to shrinkage of tissues underneath the skin. Only one side of the face is often affected. It also rarely extends to other parts of the body. Females are most commonly affected by this disease. Onset is often between 5 to 15 years of age. Other associated morbidities include those of a neurological, ocular and oral nature. Severity of this condition varies between patients. Patient with Parry Romberg syndrome referred to our hospital This middle aged male from Tirupati presented to our hospital for management. He has undergone previous surgeries elsewhere. The patient presented with nose, lip and chin asymmetry. He desired establishment of symmetry to the face. Treatment planning and surgery explained to the patient Dr SM Balaji examined the patient and ordered diagnostic studies. He explained that fascia lata graft from his thigh needed to be harvested for this surgery. The patient agreed to the treatment planning and consented to surgery. Successful surgical correction of the patient’s facial asymmetry Under general anesthesia, an S shaped incision was first made on his lateral thigh. The incision was then closed after harvesting a fascia lata graft. Attention was next turned to the chin asymmetry. A vestibular incision first made in the anterior mandibular region. Dissection was then carried down to the chin and an osteotomy done. The osteotomized piece of chin bone was then repositioned and screwed in place. This resulted in establishment of chin symmetry. The incision was then closed with sutures. Attention was next turned to the upper lip. A midline incision was then made on the inner aspect of the lip. The fascia lata strip was then tunneled from the corner of the lip on the left to the midline incision. This was then sutured and secured. This resulted in establishment of lip symmetry. Attention was then turned to the nasal asymmetry. Intranasal incisions ensured absence of any visible scars. Lateral osteotomies were then performed of the nasal bone. The medial cartilage was then partially excised from the nasal septum. This resulted in good nasal symmetry. The patient recovered from general anesthesia without event. He expressed his happiness at the results before final discharge from the hospital. Surgery Video
Crouzon Syndrome – Le Fort III Advancement Surgery by Internal Distraction Osteogenesis
Physical characteristics of Crouzon syndrome Crouzon syndrome is a rare genetic disorder with premature fusion of a few skull bones. This fusion prevents the skull from growing in all three dimensions. The shape of the head and face is most affected by this along with the mid-facial structures. This leads to wide-set, bulging eyes due to shallow eye sockets. The retruded middle part of the face results in an abnormal appearance. Surgery is the only treatment modality for adult patients. Patient with retruded midface presents for surgery This is a 15-year-old from Ajmer, India. He had undergone surgery for craniosynostosis elsewhere at 10 years of age. He presented to our hospital for facial reconstruction. His midface retrusion was causing him breathing and eating difficulties. Dr SM Balaji examined the patient and ordered diagnostic studies. He explained his proposed treatment plan to the patient. This would involved a Le Fort III advancement. The patient and his parents agreed to the treatment plan. Midface advancement from skull for Le Fort III Under general anesthesia, an incision was first made over the old scar. A bicoronal flap was then raised. The scalp was then dissected till the glabella and supra-orbital notch. Plates from the previous surgery were first removed. Careful bony cuts were next placed in four regions. These were the zygomatic arch, frontozygomatic sutures, floor of orbit and nasion. In the midline, the vomer and the ethmoid bone were then separated from the cranial base. Pterygomaxilary dysjunction was first done through the intraoral approach. His entire midface was now detached from the skull. Kawamoto distractors placed for midface advancement Attention was next turned towards placement of the Kawamoto distractors. First, the right temporalis muscle was dissected to gain access to the area. The distractor was then fixed with the help of screws to the skull and to the orbital border. Distraction was next tested and found to be perfect. The same procedure was next performed on the left side. After surgery, a latency period of six days was then given for bone stabilization. Distraction of 1 mm each day will be performed until adequate advancement of the midface. A total of 18 mm distraction was planned for this patient to be performed over a period of 18 days. The patient recovered from general anesthesia without event. The distractor will be kept in place for three months for bony consolidation. It will then be removed to be followed by orthodontic treatment. Postsurgical results were very satisfying for the patient and his family. He and his family expressed their gratitude before discharge from the hospital. Surgery Video
Successful surgical correction of the upper lip and nose defect using Abbe flap
This patient is a 30 year old native of Shimla. He was born with a bilateral cleft lip and palate. The patient has undergone primary cleft lip and palate surgery elsewhere when he was as an infant. He complained about nongrowth of hair in the center of the lip(prolabial region). The patient now has a depressed dorsum of the nose. The nose is at an obtuse angle. The patient was very specific about his appearance. He said this caused him to lack self confidence Rhinoplasty nose deformity specialist Dr SM Balaji planned the surgery. He planned to correct both the nose and lip defects using open rhinoplasty and Abbe flap. The columella of the nose was constructed using prolabium. The raw surface of the upper lip was then corrected by using a switch flap. The base of the flap was then kept attached to the lower lip for retention of blood supply. Once blood supply has been re-established in the upper lip, the flap division was then done. The defective upper lip and nose now had a more natural and esthetic appearance. The patient was very satisfied with the results.
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.
Infected dentigerous cyst-Segmental Resection & Reconstruction Surgery
Patient presents with swelling in the anterior mandible This patient is a middle aged lady from Villupuram. She first noticed a swelling on the left side of her mandible. This had led to a gradual loosening of the anterior mandibular teeth. An increase in the size of the swelling alarmed her and she went to a dentist. He obtained an x-ray, which revealed a cyst. Suspecting a simple cyst, the dentist had removed the cyst, which had an impacted tooth within it. The swelling however returned and became infected. He then referred her to our hospital for further management. Biopsy confirms diagnosis of infected dentigerous cyst Dr SM Balaji examined the patient and ordered diagnostic studies and a biopsy. Biopsy revealed the presence of an infected dentigerous cyst. The patient agreed to surgery after the treatment plan was presented to her. Rib grafts obtained to fill in area of bony defects after enucleation Under general anesthesia, two rib grafts were first obtained from the patient. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers with sutures. Successful enucleation of dentigerous cyst followed by bone graft A mucogingivoperiosteal flap was first raised and the region overlying the cyst exposed. The cyst was then enucleated in toto along with the extraction of teeth overlying the cyst. The rib graft was then shaped into pieces to fit into the bony defect. These pieces were then fixed with screws and the flap sutured. The patient recovered from general anesthesia without any complications. Surgery Video
Square face correction with large masseter and enlarged gonial angle reduction
Young man presents for square face reduction surgery The patient is a young man with a broad face due to large masseter and enlarged gonial angle. He had always been unhappy about this and desired surgical correction. He presented to our hospital to undergo square face correction. Dr SM Balaji explained the treatment plan to the patient who agreed to the surgery. Square face reduction surgery Under general anesthesia, a left-sided mandibular vestibular incision was first made. Dissection was then carried down to the region of the gonial angle and masseter. Excess masseter muscle was then removed followed by reduction of the gonial angle. This resulted in adequate reduction of left facial breadth. The same procedure was then carried out on the right side. The patient is very happy with the results After adequate reduction had been obtained, the incisions were then closed with sutures. The patient expressed his happiness at the results before discharge from the hospital. Surgery Video
Depressed Nose Augmentation Rhinoplasty Surgery
Young lady desiring surgical correction presents to hospital This young lady is from Madurai. She had always desired a sharp nose. Desiring surgical correction, her family had searched for the best nose correction surgeon. This led them straight to our hospital. Examination of the nose with detailed treatment planning Dr SM Balaji examined the patient and recommended costochondral graft placement. This would raise the bridge of the nose and give the patient’s nose a sharp profile. The patient was in agreement with this treatment plan. Harvesting of costochondral rib graft from the patient Under general anesthesia, a costochondral graft was first harvested from the patient. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. Following this, the incision was then sutured in layers. Surgical augmentation of a depressed bridge of the nose Attention was then turned to the nose. All incisions were intranasal to avoid scar formation. The costochondral graft was then crafted to the right size. This was then tunneled to the bridge of the nose and stabilized with sutures. The patient now had a sharp nose with a straight bridge. The patient expressed her happiness at the results of the surgery before discharge.
Fibrous Dysplasia Bulk Reduction Surgery
Young boy presents with fibrous dysplasia This young boy is from Nellore. He has the diagnosis of fibrous dysplasia. Fibrous dysplasia is a disorder of the bone where fibrous tissue develops in place of bone. This weakens bone and can lead to fractures. The patient has this swelling straddling his nose and extending on both sides. His parents brought him to our hospital for reduction of the fibrous tissue. A local dentist referred them here for cosmetic surgery. Patient examined and treatment plan explained in detail Dr SM Balaji examined the patient and ordered radiographic studies. Diagnosis was confirmed as fibrous dysplasia. He explained the treatment planning to the parents who agreed to the surgery. Surgery for fibrous dysplasia done with good esthetic results A vestibular incision was first made in the anterior maxillary region. Dissection was then done down to the fibrous tissue overlying the nasal region. The fibrous tissue was burred and trimmed until attaining normal facial anatomy. Incision was then closed with sutures. The patient and his parents expressed their satisfaction before final discharge.
Dentigerous Cyst -Simple Enucleation Surgery
Boy with swelling referred to our hospital for treatment The patient is a little boy from Vadodara. He had complained of a swelling in his left jaw. His parents took him to a local dentist. The dentist suspected this to be a dentigerous cyst. He then referred them to our hospital for management. Dentigerous cyst confirmed and treatment plan explained Dr SM Balaji examined the patient and ordered a 3D CT. This revealed a dentigerous cyst with an impacted second molar within it. He advised surgical removal of the cyst and the parents agreed. Dentigerous cyst enucleated without any complications Under general anesthesia, a mucogingivoperiosteal flap was first raised. This exposed the bony swelling enclosing the dentigerous cyst. The cyst was then enucleated and removed. Following this, the flap was then sutured back into position. The patient recovered without event from the surgery
Macrostomia, Tongue tie and Ear tags, extra Ear Lobule Correction Surgery
A long drawn search for the best facial cosmetic surgeon for this child This 5-year-old girl from Itarsi was born with a mouth that was very wide on the right side. The medical term for this condition is macrostomia. Her macrostomia and hemifacial microsomia resulted in underdevelopment of her right face. There may be absence of external ear in this condition. Ear tags may be present. The ear tags may contain cartilaginous tissue. If so, they need to be first dissected, repaired and sutured back. This child will need several surgeries later for reconstruction of the lower jaw. Macrostomia correction is first done and the ear tags removal is then done. She needs complete follow up of growth of mandible on the right side. She also had a tongue tie and ear tags with an extra lobe of the right ear. The tongue tie was causing abnormal speech patterns in the child. Her parents had searched far and wide for the best facial deformity surgeon to correct this. Their search had been futile for many years. It was only around six months ago that they met the parents of a similar child. Surgery performed for that child at our hospital had resulted in perfect correction. This led the parents of this little girl straight to our hospital. Treatment plan explained to the parents Dr SM Balaji examined this little girl and ordered diagnostic studies. He explained the proposed surgical plan to her parents. They were in complete agreement with his treatment plan. This was the first stage of surgical correction for this little girl. Tongue tie and macrostomia correction surgery Under general anesthesia, the tongue tie was first addressed. The lingual frenum was then dissected free to enable full extension of the tongue. This would enable normal speech for the child. Attention was next turned to the macrostomia correction. The vermillion border on the right side was first dissected. The excess tissue was then removed. The vermillion border was then sutured to ensure symmetry of the lips. Ear tag and extra ear lobe removal surgery Attention was then directed to the ear tags and extra ear lobe on the right. The ear tags were first dissected free and excised. The extra ear lobe was also addressed in similar fashion with good esthetic results. Suturing of all incisions completed the surgical procedure. The patient’s parents expressed their complete satisfaction with the results before discharge. Surgery Video