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Asymmetry correction with angle of mandible reduction and masseter debulking surgery

Patient with masseter hypertrophy and excess lateral mandibular angle bone The patient is a young girl from Rajasthan. She began noticing the development of an asymmetry in her face at around 14 years of age. The right side angle of the mandible region was becoming bulkier as time went by. It reached the point where the asymmetry became too obvious to ignore. She wanted to get it corrected. A local dentist advised her that surgical correction was the only way to correct it. She and her parents researched the Internet for the best oral surgeon. Their search led them to our hospital in Chennai. They got in touch with the hospital manager who asked them to send a few photos through email. Lateral angle of mandible reduction and masseter debulking surgery Dr SM Balaji examined the photographs in detail and instructed the patient to meet him. The patient and her parents came to our hospital in Chennai. He examined the patient in detail and explained the problem. The patient had excessive thickness to the lateral angle of mandible bone. This had to be first reduced. There was also masseter muscle hypertrophy that needed to be set right. This would be by removing excessive muscle tissue. The patient and her parents were in complete agreement with the treatment plan. The patient was then scheduled for surgery. Surgical correction of masseter hypertrophy and angle reduction Under general anesthesia, an incision was first made buccal to the right lower molars. The third molar was then elevated and removed. Dissection was then carried down to the lateral angle of the mandible. A hand piece was then used to trim down the excessive cortical bone on the lateral aspect of the mandible. Attention was next turned to the masseter muscle. Excessive muscle tissue was next trimmed until symmetry of both sides was achieved. The incision was then closed with sutures. The patient expressed her happiness to Dr SM Balaji with the results of the surgery. Surgery Video: width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Large Dentigerous Cyst Enucleation Surgery

Dr SM Balaji diagnoses dentigerous cyst in a little Bangladeshi boy This little boy from Bangladesh developed a swelling in the front region of the upper jaw. The swelling kept increasing in size. His worried parents brought him to India for treatment. They enquired about the best hospital to get their son treated. It was during this time that they met a dental surgeon in Kolkata. He recommended Balaji Dental and Craniofacial Hospital, Teynampet, Chennai to them. They made enquiries and presented at the hospital with their son. Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient and ordered comprehensive imaging studies. A 3D axial CT scan revealed a dentigerous cyst in the anterior maxillary region. He explained the condition to the boy’s parents and advised surgical excision of the cyst. The parents consented to the plan of action and the patient was then scheduled for surgery. Surgical enucleation of the cyst by Prof SM Balaji Under general anesthesia, teeth in the region were then extracted using forceps. A mucogingival flap was then raised to the region of the anterior maxillary sulcus. The region of the dentigerous cyst was then accessed. Cyst was next enucleated completely along with the unerupted tooth inside it. The flap was then sutured closed. The patient recovered well from general anesthesia.

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Zygoma Reduction Surgery for Fibrous dysplasia with protection of infraorbital nerve surgery

Presentation of fibrous dysplasia Fibrous dysplasia is a very rare disorder of the bone. The gene involved is the G-protein receptor. It is a condition where fibrous tissue replaces normal bone and marrow tissue. This results in bone that is very weak. There is also excessive proliferation of this fibrous bony tissue. This leads to increased size of the affected bone. Surgical correction is the only solution for fibrous dysplasia. A patient with fibrous dysplasia presents at Balaji Dental and Craniofacial Hospital This patient presented to Balaji Dental and Craniofacial Hospital for treatment. He had increased asymmetric growth of the right zygomatic bone. Dr S M Balaji, Craniomaxillofacial surgeon, examined the patient and ordered investigations. Biopsy revealed it to be fibrous dysplasia. He explained the condition to the patient and his treatment plan. The patient was in complete agreement with the treatment plan. Surgical correction of fibrous dysplasia Under general anesthesia, an incision was first made. This extended from the outer canthus of the right eye. Dissection was then carried down to the frontal part of the zygomatic bone. Next, a vestibular incision was then made in the right maxillary sulcus. Dissection was next carried down to the dysplastic zygomatic bone. Fibrous tissue of the zygomatic bone was next trimmed with burs and chisels. Access was through both incisions. Adequate trimming of fibrous tissue was then completed and facial symmetry restored. The incisions were then closed with sutures. Great care was always taken to preserve the infraorbital nerve. Testing of the nerve at the end of surgery revealed no neuropraxia or other signs of nerve injury. The patient expressed his happiness at the results of the surgery before discharge.

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Occipital Protuberance of the skull Reduction Surgery

The patient’s friend refers him to Dr SM Balaji for deformity correction The patient is a young man with a bony unevenness in his posterior occipital region. This has been present ever since he can remember. He recently came to know from a friend that this irregularity could be set right. His friend referred him to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Dr SM Balaji explains treatment plan to the patient He presented to our hospital and Dr S M Balaji, oral and maxillofacial surgeon, examined him. Dr S M Balaji ordered a 3D axial CT scan along with accompanying laboratory tests. He explained the surgical process to the patient. The patient was in complete agreement with the treatment plan. Surgical procedure performed on the patient Under general anesthesia, a 3 inch vertical incision was first marked out. This was over the irregularity in the occipital bone. The posterior scalp was first incised and reflected. The bone was then exposed and then trimmed using surgical burs until the surface was even and smooth. The incision was then closed in layers with sutures and staples. The patient expressed his satisfaction at the results of the surgery to Dr. Balaji. He was then discharged from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Palatonasal and Bucconasal Fistula Closure Surgery

Initial Presentation: The patient presented at Balaji Dental and Craniofacial Hospital, Teynampet, Chennai with complaints of regurgitation of fluids from the oral cavity into the nose for a very long time. The patient stated that there were “two holes” in the bone on the right side of his upper jaw. Diagnostic Tests: Dr. SM. Balaji, Cranio-Maxillofacial Surgeon, examined the patient and ordered radiographic studies for diagnostic confirmation. He explained to the patient that the “two holes” were oronasal fistula that were connections between the oral cavity and the nasal cavity. He further explained how these were causing the patient’s regurgitation problems. He added that surgical correction was the only solution for this. The patient was in agreement with this plan of treatment and was scheduled for surgery. Surgical Procedure: Under general anesthesia, a palatal flap was raised for closure of the palatonasal fistula. The epithelialized portion of the fistulous tract was excised and tissue was mobilized around the fistula, which was then closed with the palatal flap. Following this, a mucogingival flap was raised for closure of the bucconasal fistula. The epithelialized portion of the fistulous tract was excised followed by mobilization of the tissue around the fistula. The flap was then utilized to close the fistula. The patient was then extubated and recovered uneventfully from general anesthesia.

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Unilateral Cleft Lip Correction Surgery – Dr. SM Balaji, Maxillofacial Surgeon, India

Baby boy is born with a unilateral cleft lip and palate: This baby boy is the grandson of a famous merchant in Bangalore, Karnataka. He was born with a severe form of unilateral cleft lip and palate. There was a wide cleft space with ill developed segments. Balaji Dental and Craniofacial Hospital, a world-renowned cleft surgery centre: The family searched far and wide for the best cleft surgeon in India. They made enquiries all over the country, including all metro cities. Friends too joined in the search for the best hospital. One friend finally zeroed in on Balaji Dental and Craniofacial Hospital in Chennai. Further enquiries revealed it to be a world-renowned centre for cleft correction. The parents then made discreet enquiries about the hospital. Once satisfied, they presented at our hospital for repair of the cleft deformity. Dr SM Balaji, Cranio-maxillofacial surgeon, examined the baby. He decided to perform a modified Millard’s Technique to repair this baby’s cleft lip defect. Dr Balaji explained this to the parents in detail. The parents consented to the operation. Perfect adaptation of the cleft halves of the upper lip: A modified Millard’s technique leads to less scarring. It also gives better functional and esthetical results. Customization of the approach depends upon the degree of cleft and muscular involvement. Being ambidextrous (the ability to work with both hands) is an advantage for this surgery. A modified Millard’s flap was first employed. The C flap was then used to recreate the nasal sill while the M flap was next used to create the floor of the nose. All tissues were well used in the reconstruction and there was no tissue wastage. There was a perfect adaptation of the two halves of the cleft. Need for further surgeries explained to the parents: The need for further surgeries was then explained to the parents. This would be necessary for the complete rehabilitation of the baby’s deformities. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Medial Tarsorrhaphy of the eye for Ptosis

[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=”4.9.4″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” hover_enabled=”0″ sticky_enabled=”0″] Prof SM Balaji plans ptosis surgery for the patient A patient is a young man who was unable to close his left eye due to ptosis. This was leading to continuous drying of the eye with the potential for damage to the cornea. He presented to Dr. SM Balaji, Craniofacial Surgeon, Chennai, for correction of his problem. Dr. Balaji decided thttps://www.smbalaji.com/dr-sm-balaji/o proceed with a medial tarsorrhaphy. Successful surgical correction of the patient’s ptosis An incision was first made inferior to the left eyelid margin. This was medial to the punctum and through the skin and orbicularis muscle. This incision was then extended to the medial canthus. It was then continued along the upper eyelid. This was in a similar fashion such that it presented as a sideways V-shaped incision. Dissection was then carried out between the anterior and posterior lamella. This was along the length of the incision. The posterior lamella of the upper and lower eyelid was then sutured together with interrupted sutures. Care was always taken to ensure that the canaliculus was not damaged by the sutures. The anterior lamella was then sutured together with Vicryl sutures. These anterior lamellar sutures should not be too far medial. This is to avoid formation of a webbing deformity in the region. The patient tolerated the procedure well. Surgery Video [/et_pb_text][et_pb_video _builder_version=”4.9.4″ _module_preset=”default” src=”https://www.youtube.com/watch?v=bma_uFiiTyw” hover_enabled=”0″ sticky_enabled=”0″][/et_pb_video][/et_pb_column][/et_pb_row][/et_pb_section]

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Velopharyngeal insufficiency (Hypernasality) Nasal Speech Correction Surgery for Cleft Palate- Pharyngoplasty with positive suction test

Initial Presentation This young man from Yangon, Myanmar, had been born with a cleft lip and palate and had undergone cleft repair as an infant. He had subsequently developed velopharyngeal incompetence, where there is escape of air through the nose during speech. This had lead to him having difficulty pronouncing certain words well and he also had a nasal twang to his voice. He had very limited mouth opening. He presented to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai for surgical correction of his speech difficulties. He had been referred to a speech pathologist who advised him for a sphincter pharyngoplasty surgery to correct his velopharyngeal incompetence/hypernasality. Treatment Planning and Surgery Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined him and advised him that he needed a pharyngoplasty surgery for correction of his problem. The patient agreed to this and was scheduled for surgery. This surgery is performed for the creation of a dynamic sphincter in the pharynx by repositioning of the palatopharyngeus muscle. The patient was taken to the operating room and underwent general anesthesia without complications. Incisions were made to release the posterior faucial pillars, including the palatopharyngeus muscle. These were then crisscrossed and sutured together on the posterior pharyngeal wall. This formed a sphincter along with the formation of a small opening or “port” for the patient to breathe through his nose. Though his mouth opening was very limited, his sphincter pharyngoplasty was very successful. Successful Positive Suction Test Demonstrates Successful Surgery Successful demonstration of a positive suction test at the completion of the surgery revealed a dynamic velopharyngeal sphincter action thus indicating successful correction of his velopharyngeal incompetence. The patient was then extubated and recovered from general anesthesia without complications.

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Periapical Cyst Enucleation, retrograde filling with MTA and defect filling with Bio-Oss

Presence of periapical cyst The patient is a young man who presented at Balaji Dental and Craniofacial Hospital, Chennai, with pain in the upper left central incisor, which had previously undergone root canal treatment elsewhere. Radiographic investigations conducted revealed a periapical cyst in relation to the tooth. Dr S M Balaji, Cranio-Maxillofacial Surgeon, decided to perform enucleation of the periapical cyst followed by retrograde filling of the root apex with Mineral Tri-Aggregate (MTA) and filling of the bony defect with Bio-Oss. Cyst removal with filling of defect The patient was taken to the operating room and a mucogingival flap was raised to the level of the root apex. A window was created in the bone and the cyst was removed in its entirety. The root apex was cut (apicoectomy) and removed following which the stump was retrograde filled with MTA. The bony defect was then closed with Bio-Oss and the flap was sutured back into anatomical position. Successful resolution of infection The patient underwent regular post-operative checkups over a period of six months and x-rays showed complete resolution of the infection with filling in of the bony defect with new bone.

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Facial Paralysis – Reanimation by Temporalis and Fascia lata Dynamic Sling Surgery

Indian Academy of Maxillofacial Surgeons’ Advanced Craniofacial Surgery Workshop The Indian Academy of Maxillofacial Surgeons conducted their Advanced Craniofacial Surgery workshop on “Current Advances in Cranio-Maxillofacial Surgery” at Hitkarini Dental College and Hospital & Jabalpur Hospital and Research Centre, Jabalpur, on February 15-18, 2018. Many leading Cranio-Maxillofacial surgeons from around the world participated in this workshop. The programme director was Prof. J.N. Khanna and the programme coordinator was Dr. Rajesh Dhirawani. Foreign Faculty at the Workshop Prof. G. E. Ghali, Chancellor and Dean, LSU Health Sciences Center and Gamble Professor and Chairman, Oral and Maxillofacial Surgery -Shreveport, USA and his entire team of key opinion leaders played the role of mentors for this huge workshop. Other foreign faculty who were present at the workshop were Dr. Andrew Meram, Dr. Mary Laura Hastings, Dr. Ahmed Tamim and Dr. Hendell Nealy. Dr. S.M. Balaji Invited for Demonstration of Congenital Facial Palsy Correction Surgery Prof. Dr. S. M. Balaji was invited as a key operating faculty for this workshop. A case of congenital facial palsy was allotted to Prof. Dr. S. M. Balaji to demonstrate the facial reanimation procedure. Planning for the Dynamic Temporalis Sling Surgery The patient was a middle-aged male who had congenital facial palsy and facing a lot of health and social issues due to the facial palsy. Due to case selection and studies were performed. Considering all clinical and anatomical factors, a dynamic facial reanimation using Tensor fascia lata along with partial Tarsorrhaphy (surgery for joining of part of the upper and lower eyelids so as to partially close the eye) was planned. There were about 200 postgraduates and young oral surgeons from across India as the audience. The surgery was planned as an interactive session where the audience asked questions to operate faculties. Live Surgical Demonstration with Commentary by Prof. S.M. Balaji The patient suffered from a congenital lower motor neuron type of paralysis. To correct this condition, a strip of fascia lata from the vastus lateralis was first harvested. The next step of the surgery was performed through a combined preauricular and intraoral approach. The insertion of temporalis into the coronoid process was released at the infratemporal area. The zygomatic arch was carefully cut and pushed down to free the temporalis muscle. Care was taken to preserve all the vital structures such as the parotid duct and gland in this area. This action was carried out without disturbing the deep temporal artery and nerve. Then through careful manipulation, the lower end of temporalis was identified to which an end of the fascia lata was attached. Through a nasolabial incision, the modiolus was identified. The free end of fascia lata was split into three parts – the lower part was connected to muscles of the lower lip, the middle part to the modiolus and the upper part to the upper lip. The connections were checked and ensured that the muscle attachments were secured and the dynamic facial reanimation was confirmed by the action of the muscles. To take care of the improper eye closure, a partial lateral tarsorrhaphy was performed. The patient recovered well. Post-surgical Conference by Dr. S.M. Balaji Prof. S. M. Balaji cleared doubts from the audience regarding the surgical procedure and carefully mentioned the tips for this kind of surgeries that he has learned over the years. The surgery was well-received by all at the workshop.

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