Cleft Orthognathic Surgery, LeFort I Advancement for Bilateral Cleft Lip and palate Surgery
Young Nepali girl with extreme crossbite of the jaws This teenage girl from Kathmandu, Nepal was born with a bilateral cleft lip and palate. Her parents brought her to our hospital for correction of her deformities. She had undergone cleft lip repair at two months of age and cleft palate surgery at 10 months of age. She had surgery with rhBMP-2 for repair of her cleft alveolar bone at 4-1/2 years. This was to repair and unite the maxilla, which was in three segments. She had developed an anterior crossbite due to deficient growth of the maxilla. As a result, she has had difficulty with eating and speech all her life because of her crossbite. Her parents decided to get her problem corrected through surgery. They then brought her back again to our hospital for correction of her problem. Treatment planning for crossbite correction Prof SM Balaji, Cranio-maxillofacial surgeon, examined the patient. The patient was very familiar to him as he was her surgeon since her infancy. He ordered a 3D axial CT scan and other pertinent studies. Once he had decided on the treatment plan, he explained it to the parents and the patient. They were in complete agreement with his plan of treatment. Surgical correction of the patient’s crossbite A maxillary vestibular incision was first made after induction of general anesthesia. A maxillary osteotomy was then performed. The osteotomized maxilla was then advanced forwards to correct the anterior crossbite. This was done utilizing two plates on each side with four screws per plate. It was for stabilizing the maxillary bone during the healing period. The bite was then checked and there was complete correction of the crossbite. Incisions were then closed with sutures. The patient expressed complete satisfaction with the results of the surgery. Surgery Video
Cosmetic Rhinoplasty – Nasal Bridge Augmentation & Alar Base Reduction Surgery
Searching for the best rhinoplasty surgeon in India The patient is a young woman who always wanted a sharp nose with a straight bridge. She had always felt that her nostrils were too wide for her face. A doctor in her hometown suggested that she undergo rhinoplasty. She and her parents searched for the best rhinoplasty surgeon in India. They finally decided to come to our hospital for surgery. Treatment plan explained to the patient Dr SM Balaji, Rhinoplasty specialist, examined the patient upon arrival at the hospital. He explained to the patient and her parents that she needed a rib graft. The patient and her parents were in agreement with the treatment plan proposed by him. Rhinoplasty procedure performed on the patient Under adequate general anesthesia, a rib graft was first obtained from the patient. A Valsalva test was then performed to confirm that there was no perforation of the thorax. Attention was next turned to the nose. An intranasal incision ensure that there would be no external scar formation. The bone graft was then tunnelled through the incision to lift up the bridge of the nose. Alar reduction was then performed to reduce the width of the patient’s nostrils. The patient and her parents expressed their happiness at the results of the surgery.
Unilateral Cleft Lip and Palate Rhinoplasty
The patient presents for rhinoplasty This young child was born with a right sided cleft lip and palate. She had undergone corrective surgery of her cleft lip as an infant. She now presents for rhinoplasty for correction of her nasal deformity. Surgical correction utilizing rib grafts Under general anesthesia, an incision was first made. A rib graft was then harvested from the patient. Valsalva maneuver demonstrated patency of the thoracic cavity. The incision was then closed in layers. The graft was then crafted for use as a strut graft and an alar cartilaginous graft. Attention was next directed towards the nose. Intranasal incisions were then made to avoid scar formation. The cartilaginous graft was then tunneled into position and stabilized with sutures. Scar revision and alar skin removal procedure Attention was next turned to the scar from the old cleft lip surgery. Scar tissue was first marked and then removed. A small strip of tissue was then incised and removed from the outer aspect of left alar region. This was then closed with sutures. The procedure resulted in establishment of symmetry of the nostrils. Surgery Video
RTA-Multiple Surgeries with Pseudarthrosis Re-surgery and Bone Grafting
Pseudarthrosis of mandibular fracture after many surgeries post RTA This patient ended up with a horrific fracture to his mandible after a RTA(Road Traffic Accident). He has had four surgeries elsewhere in attempts to correct this. Reconstruction plates used did not heal the fracture site. Each surgery had only led to further worsening of his condition. He ended up with shortening of his mandible on the left side with associated numbness of lip. There was a 2-inch gap at the fracture site with nonunion of his mandibular fracture. The wound had a chronic infection with formation of granulation tissue. This had led to pseudarthrosis and asymmetry of his face. The patient was feeling very frustrated and hopeless with his situation. He could not even eat well because of the malocclusion. Determined to do something about this, he turned to the Internet. He did extensive Internet research for the best maxillofacial surgeon. This led him straight to our hospital for surgical correction. Patient presents for correction of nonunited fracture Dr SM Balaji examined the patient and ordered extensive imaging studies. He explained to the patient that he needed bone grafting for his 2-inch mandibular defect. The patient was in agreement with this treatment plan. Surgical correction of nonunited left mandibular fracture After adequate general anesthesia, the preexisting lower archbar was first removed. IMF done with stainless steel wires stabilized the jaws in correct anatomical position. A left sided gingivomucoperiosteal flap was then raised. The flap was then reflected to expose the region of the fracture. There was a 2-inch bony gap with complete nonunion of the fracture. Presence of granulation tissue was also noted. The old titanium plate was then unscrewed and removed. This was next replaced with a thinner new titanium plate. Granulation tissue was then removed. A rib graft was then harvested from the thoracic region. Following this, a Valsalva test demonstrated thoracic patency. This incision was next closed with subcuticular sutures. Stabilization of the fracture segments The rib graft was then sectioned to fit into the nonunited fracture site with miniplates. Rib graft pieces were then positioned at the nonunion site and screwed in place. Use of miniplates achieved this. This would ensure complete union of the fractured mandibular bone. The flap was then closed with sutures. Occlusion reestablished for the patient Occlusion was then checked and found to be perfect. Intermaxillary fixation was then released. The patient expressed his happiness at the results before discharge.He presented the hospital with a glowing handwritten testimonial about his experience here. Testimonial Surgery Video
Infected Dentigerous Cyst, Complete Enucleation and Alveolar Bone Reconstruction with Rib Graft
An introduction to dentigerous cysts and their etiology A dentigerous cyst forms around the crown of buried or unerupted teeth. They are most often found in relation to mandibular third molars. These teeth are the ones that are most often found impacted. Accidental discovery is the common with dentigerous cysts. This happens when x-rays taken for other mundane issues reveal their presence. They sometimes become infected and cause pain or swelling, leading to their discovery. Young man with long standing pain presents for treatment This young man developed pain in the right posterior mandibular region. He then presented to our hospital for treatment. Radiographs and 3-D axial CT scans were first obtained. These showed a bony lesion in the right mandibular ramus and third molar region. A biopsy showed it to be an infected dentigerous cyst. Dr SM Balaji, Cranio-maxillofacial surgeon formulated a treatment plan. This was to enucleate the dentigerous cyst. Reconstruction of the ramus would follow with rib grafts. The patient agreed to surgery and was then taken to the operating room. Dentigerous cyst removal surgery Under general anesthesia, a rib graft was first harvested. A Valsalva maneuver was then performed before closure of incision. This was to ensure that there was no perforation into the pleural cavity. A sulcular incision was then made in the right mandibular posterior region. This was next followed by raising a gingivomucoperiosteal flap to expose the lesion. The dentigerous cyst was then completely enucleated and the entire cyst lining removed. The involved region of the jaw was then reconstructed using the rib graft. Sutures were then used to close the incision. The patient made a complete recovery from the surgery before discharge home. Surgery Video
Long standing facial paralysis static suspension of orbicularis oris fascia Lata Surgery
Young man with facial paralysis presents for treatment This young man presented at our hospital for treatment. He is suffering from long standing facial paralysis. Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient. He explained the treatment process to the patient. This would involve surgical correction to restore actions of facial expression. The patient was also counseled about the extent of possible correction. A strip of fascia from the vastus lateralis muscle of the thigh would be harvested for this purpose. He expressed understanding of the procedure and gave consent for the surgery. He was then scheduled for surgery. Facial expression reestablished with fascia lata graft A nasolabial incision was first made and the orbicularis oris muscle exposed. A preauricular stab incision was first made. Then the harvested strip of fascia lata was tunneled to the orbicularis oris muscle. The orbicularis oris muscle was then overlaid on the fascia, which was then sutured to the muscle. This incision was then closed with sutures. The other end was then sutured to the region of the preauricular stab incision, which was then closed. The patient tolerated this procedure well and recovered from general anesthesia.
Unilateral Cleft Rhinoplasty Surgery
Rhinoplasty for cleft lip and palate related nasal deformity The patient is a young woman who had been born with a left sided cleft lip and palate. She underwent cleft lip repair surgery elsewhere as an infant. Past surgical history of the patient She has undergone alveolar bone grafting and orthodontic treatment here at our hospital. A LeFort 1 maxillary advancement surgery was also done here. She now presents for rhinoplasty for correction of her nasal deformity. This is her final surgery. Rib grafts used to correct the nasal deformity Under general anesthesia, Dr SM Balaji harvested two costochondral rib grafts. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Rib grafts were then crafted into the right size and shape. Following this, bilateral intranasal incisions were then made. The nasal bone was next fractured and then set right to correct the deviation in the nasal septum. The cartilaginous grafts were next positioned through the incisions and stabilized with sutures. This resulted in reestablishment of nasal symmetry. The patient and her parents were very happy with the results of the surgery. They expressed this to Dr SM Balaji before discharge from the hospital. Surgery Video
Oronasal Fistula Closure, Orbital Floor Reconstruction, Augmentation Rhinoplasty and Zygomaticus plication
Extensive fractures of the facial bones and failed treatment This young lady is in her early 20’s. She met with an automobile accident on the way back home from work. This resulted in panfacial fractures. She was first taken to a nearby hospital for first aid. Following this, she was then admitted elsewhere for repair of her facial fractures. It took around 6-8 months for her facial swelling to subside. She then realized to her dismay that fixation of her fractures showed deformity. The patient now had a degree of facial disfigurement. Initial presentation and investigations She was in distress over this. It was then that she presented to Balaji Dental and Craniofacial Hospital, Chennai. The purpose of her visit was for posttraumatic deformity correction. Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient. He next ordered extensive imaging studies including 3D axial CT scans. This revealed that she had suffered panfacial fractures. The fractures involved the nasoorbitoethmoid (NOE) complex. Fractures to the orbital floor and the palatal part of the maxilla were also seen. The NOE complex fracture had left her with a saddle nose deformity due to flattening of the nasal bridge. She also had a degree of right-sided facial nerve palsy. There was also an oronasal fistula from improper closure of the palatal fracture. Closure of her oronasal fistula and orbital floor reconstruction planning Dr. Balaji explained to her that she needed closure of the oronasal fistula first. Next would be orbital floor reconstruction and augmentation rhinoplasty using rib grafts. She would then have zygomaticus plication for correction of her residual palsy. He described the surgical process in detail to the patient. Her parents and she were in agreement with the treatment plan. The patient was then scheduled for surgery. Surgical correction of deformities using rib grafts and surgical plates Rib grafts were first obtained after successful induction of general anesthesia. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Attention was then turned to the oronasal fistula. This was then closed with a palatal rotation flap. Attention was next turned to the augmentation rhinoplasty. A graft was next placed through intranasal incisions. This corrected the patient’s saddle nose deformity. There were also no visible scars. The intranasal incisions were then closed with sutures. Following this, a gingivomucoperiosteal flap was next raised on the right side of the mandible. The plates that were screwed in place to fix the body of mandible fracture were next removed. The flap was then sutured in place. An incision was next made in the maxillary vestibular area. Dissection was then done up to the area of the zygomatic arch. An incision was then made over the old scar on the right cheek. This was to access the plate fixed on the zygoma. This plate was then removed. A rib graft was next screwed to the area of the bony defect in the zygoma through an intraoral approach. The incision over the right cheek was then closed with sutures. This was then followed by closure of the maxillary vestibular incision with sutures. Alar reduction surgery for narrowing the nostrils Following this, markings were then made on the outer alar reduction. Crescent shaped tissue wedges were next removed from bilateral ala. The ala were then sutured into their new positions. This resulted in reduction of the width of the nostrils. The patient recovered well from her surgery. She expressed her happiness at the results of the surgery before discharge. Surgery Video
Cleft Rhinoplasty Depressed Alar Cartilage Correction Surgery
Patient with collapsed left ala seeks best rhinoplasty surgeon The patient is a young woman from West Bengal. She had been born with a cleft lip and palate and had undergone repair of her cleft lip and palate as an infant. The patient has a collapsed left ala of the nose. This has led to asymmetry of her face, which she wants corrected now. Her parents searched far and wide for the best rhinoplasty surgeon in India. Their search finally led them to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Treatment plan explained to the patient Dr SM Balaji, cleft rhinoplasty surgeon, examined the patient. He ordered imaging studies to assess the patient. Once he had decided on a treatment plan, he explained it to the patient and her parents. They were in complete agreement with his treatment plan. Surgical rhinoplasty correction for collapsed left ala Under general anesthesia, cartilaginous rib grafts were first harvested from the patient. A Valsalva maneuver confirmed absence of perforation into the thoracic cavity. Attention was next turned to the maxillary bony deficiency. Two rib grafts were then crafted to fit into the deficiency. Screws were then used to fix the grafts into the areas of bony deficiency. Attention was next turned to setting right the collapsed left nasal ala. All incisions were intranasal to avoid scarring. The cartilaginous graft was then shaped to fit into the collapsed ala and then inserted into the ala. This lifted up the collapsed ala and there was restoration of facial asymmetry. All incisions were then closed with sutures. The patient and her parents expressed their complete satisfaction before final discharge.
Rhinoplasty – Depressed Nasal Bridge Elevation Surgery
The patient desires to undergo rhinoplasty surgery The patient is a young woman who has a depressed bridge of nose. She has never been happy with her nose. The patient had undergone maxillary osteotomy elsewhere a few years ago. Her surgeon at that hospital had expressed inability to perform nasal correction. She had searched for the best rhinoplasty surgeon in India. This had led her straight to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Treatment plan for rhinoplasty explained to patient Dr SM Balaji, nose correction specialist, examined the patient. He then ordered imaging studies for the patient. The patient still had retained plates and screws from her old osteotomy surgery. Dr. Balaji explained the treatment plan to the patient and her parents and they were in agreement. Rhinoplasty surgery Under general anesthesia, two cartilaginous rib grafts were first harvested from the patient. Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Attention was next turned to the retained hardware from the old surgery. The hardware was first removed through a maxillary vestibular incision. The incision was then closed with sutures. Attention was then turned to the nose. Intranasal incisions were then made. Lower nasal thirds of the alar cartilage was next excised and removed. The cartilaginous grafts were then inserted through the incision. This was then tunneled up to the bridge of the nose. The tip of the nose was next lifted up with the aid of a cartilaginous graft. This resulted in the patient getting a straight bridge of the nose with a nice nasal tip. The patient expressed satisfaction at the results of the surgery. She was then discharged from the hospital. Surgery Video