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Orbital Blowout Fracture, Enophthalmos and Diplopia Correction Surgery

The patient’s facial deformities from fracture reduction after a road accident A patient is a young man employed in the UAE. He got involved in a road traffic accident a little over three years ago. This resulted in fractures to the facial bones on the right side. It also included a floor of the orbit blowout fracture. The patient was first treated as an emergency at the time of the accident. This left him with residual deformities from the fracture correction surgery. The patient developed diplopia and enophthalmos as a result of the surgical correction. The patient presents for consultation with Dr. S M Balaji The patient had been searching far and wide for the right surgeon to correct the deformities. He was then referred to Dr. S M Balaji, Cranio-Maxillofacial Surgeon by an oral surgeon in the UAE. The patient first contacted the hospital manager at our hospital. She requested the patient to mail all pertinent medical records to the hospital. Dr Balaji studied the medical records in depth including all imaging studies. He informed the patient that his facial deformities could be set right. The patient presented at Balaji Dental and Craniofacial Hospital’s Trauma care unit. All preoperative investigations were then performed. The surgery was then scheduled for the patient. Successful surgical correction of the patient’s fracture Under general anesthesia, a maxillary vestibular incision was first made. The site of the zygomatic fracture repair on the right side was then accessed. The plates from the previous surgery were then removed and the area refractured with a drill. An incision was next made extending from the outer canthus of the right eye. The plate from the previous surgery was then removed and the area refractured. This was next followed by a transconjunctival incision. The site of the orbital floor fracture repair was then accessed. All refractured segments were next brought into proper alignment. A Titanium mesh with Medpor coating was then shaped to align with the floor of the orbit. This was then placed on the floor of the orbit and screwed to the lower orbital wall. Transconjunctival incision was then closed with sutures. Refractured segments of the zygomatic bone were then replated and the incision sutured. The outer canthal incision was then closed with sutures. The patient recovered without an event from general anesthesia. The patient returns back to the UAE The patient expressed complete satisfaction at the time of discharge from the hospital. There were no noticeable facial scars from the surgical procedure. He was very happy with the results of the surgery.

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Direct Sinus Lift Surgery with Allograft for Dental implant placement in Upper jaw

Dr. S.M. Balaji explains the Sinus Lift Procedure to the Patient The patient presented to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai for treatment. He was seeking replacement of missing right upper molars with implants. Dr. S.M. Balaji, Cranio-Maxillofacial Surgeon, examined the patient and ordered radiographic studies. There was inadequate bony height in the posterior maxillary region. This would lead to unsuccessful placement of dental implants by the conventional method. The patient then enquired if there were alternative treatments for implant placement. Dr. Balaji then explained the sinus lift procedure to the patient. It would done by placement of an allograft, Bio-Oss through a window in the bone. This would become consolidated into new normal bone over a period of time. The new bone would serve as foundation for loading of normal biting forces on the implants. He was in total agreement with this treatment plan and agreed to surgery. Successful Sinus Lift Procedure through Bony Window with Placement of Bio-Oss Allograft Material After infiltration of local anesthesia, a window was then made in the bone with a round bur. The window was in the lateral wall of the maxillary antrum. This wall forms the boundary of the right maxillary sinus. The sinus floor was then lifted taking care not to damage the Schneiderian membrane. This membrane is the lining of the sinus. Implants were then placed in the bone. These implants will mimic the roots of natural teeth. Allograft mixture was then prepared using approximately 1.5 mL of the patient’s blood and Bio-Oss. This was then packed into the sinus pocket tucked below the sinus lining. The height and width of the implant bearing bony area would thus increase. With time, there would be consolidation of the allograft into new bone. This new bone will provide a good bony foundation for the implants. Success of the implant treatment depends on this. The flaps were then closed with sutures. Future Placement of Ceramic Prosthesis on Implants: His next visit would be after three months. After confirmation of proper osseointegration, ceramic prostheses would then be attached to the implants. This would complete the patient’s rehabilitation process.

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Unilateral Condylar Fracture (jaw Joint) Open Reduction and Plate Fixation Surgery

The patient is a teenage boy from north India. He had a road traffic accident. This lead to development of pain and swelling in the left preauricular region. He also demonstrated deviation of his mouth to the left upon mouth opening. His parents took him to a hospital for radiographic studies. The doctor who examined him explained to them that he had a fracture of the left condyle. He added that this needed surgical correction. Since this was a difficult surgery to perform, he said it needed expert care. He then referred the patient to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. This is one of the leading Cranio-Maxillofacial Superspecialty Surgical Hospitals in India. Dr. S.M. Balaji, Cranio-Maxillofacial Surgeon examined the patient. He then ordered 3D axial CT scans. It revealed the fractured left condyle of the mandible. Dr. S.M Balaji then explained to the parents that the fracture was in a region that was difficult to approach. He said that the conventional method would not work. Only the modified preauricular incision approach would work, he explained. The parents were in agreement with the treatment plan. The patient was then scheduled for surgery. Treatment was by open reduction and internal fixation of his left condylar fracture. General anesthesia was first induced. Then Dr. S.M Balaji marked the proposed modified preauricular incision with a marker. The incision was then made with great care. This was to avoid injury to vital structures in the region. The facial nerve and the parotid gland were thus protected. Dissection was then carried down to the region of the fracture of the condyle. The fractured condyle was then plated. Plate fixation check for stability was positive. The incisions were then closed in layers with sutures. The patient recovered without event from general anesthesia. He was then scheduled for suture removal in seven day’s time. The patient presented on the seventh day after surgery for suture removal. He then demonstrated the ability to open his eyes wide, shut his eyes tight and open his mouth wide without pain. This demonstrated absence of any damage to the facial nerve. There was complete preservation of function with no neuropraxia or other neurological deficits.

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Unilateral Cleft Lip Correction Surgery – Suture Removal on 7th day

Initial Presentation: This is a 2-month-old baby boy from Sri Lanka who was born with a unilateral cleft lip and palate defect. His parents related that his elder sister had also been born with the same condition. She had been operated on elsewhere in India, but the surgery had left behind ugly residual scars. So when their son too had been born with a similar deformity, they wasted no expense in searching far and wide for a cleft lip repair specialist. They finally zeroed in on Balaji Dental and Craniofacial Hospital, Teynampet, Chennai after extensive research done over the Internet and meeting parents of previous patients. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, explained to them that the child needed primary cleft lip repair surgery using the modified Black’s technique in order to recreate a tight lip seal. A modified Black’s technique cleft lip repair was done. Suture Removal: Seven days after the surgery, the parents presented with the boy at the hospital for suture removal. There was perfect vermillion border approximation, good columellar form and good overall appearance. There was negligible scar formation, which would slowly fade away over time. The baby was also feeding well. Both esthetic as well as functional outcomes of the surgery were good. Complete Rehabilitation: It was explained to the parents of the boy that he would need further surgeries in the future, which would have to be planned out in a phased manner for further correction of his cleft defects.

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OKC – Odontogenic Keratocyst Hemimandibulectomy with total Reconstruction of Jaw (Ramus & Body of Mandible)

The patient’s presentation and history: This young 13-year-old Northeastern girl was brought to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, by her parents for treatment of a painless swelling involving the right side of her lower jaw that had been present for over a year. Her parents had not taken this slowly developing swelling seriously for a very long time and had neglected going to a doctor. It was only when it had grown to a very large size that they decided to seek medical help for their daughter. Search for a good surgeon: They had approached many hospitals throughout India, including premier surgical centers in other metropolitan cities, but had been turned away because of the extent of the lesion in her mandible. It was only after many months of futile search that they were finally referred to Balaji Dental and Craniofacial Hospital in Chennai for management of their daughter’s condition. Initial visits with Dr SM Balaji: Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient and ordered extensive investigations including 3D axial CT scans. Radiographic studies revealed the presence of an odontogenic keratocyst in the right side of the mandible, which involved both the ramus and the body of the mandible. It had spread so extensively that it had completely breached through the cortical bone of the ramus of the mandible into the soft tissues surrounding it. Dr. Balaji explained to the patient and her parents that except for the condylar region, the right side of the mandible would have to be completely removed because of the extent of the lesion. He further explained that the mandible would then be reconstructed using a titanium plate with costochondral rib grafts obtained at the same surgery. The parents were in full agreement with this treatment plan and the patient was scheduled for surgery. Obtaining Rib Grafts: After the successful induction of general anesthesia, two costochondral rib grafts were harvested from the patient. The incision was then closed in layers after a Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. Reconstructive Surgery: A right sided mucogingival flap was then raised and reflected down to the vestibular sulcus. The flap was reflected until the affected areas involving the body of the mandible was exposed. An extraoral incision was then made at the region of the angle of the mandible and dissection was carried down to the ramus. The bone in the affected regions was extremely soft and friable. A hemimandibulectomy was then performed with complete removal of the affected segment of the mandible. Reconstruction of the mandible was then performed with use of the costochondral rib grafts and the titanium plate. The incisions were then sutured close and the patient recovered uneventfully from general anesthesia. Postoperative Period: The patient and her parents expressed their thankfulness to Dr SM Balaji before being discharged from the hospital. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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Bilateral cleft lip correction surgery suture removal on 7th day

Surgical Planning: This is a 2-month-old baby girl from Bahrain was born with bilateral cleft lip and palate. Her parents were referred to Balaji Dental and Craniofacial Hospital, by a close friend of theirs whose daughter had been operated upon by Dr. Balaji with very good results. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, explained to them that the goal of this primary surgery is to recreate the lip seal. The parents consented and the child was scheduled for surgery. A modified Black’s technique cleft lip repair was done. Suture Removal: Seven days after the surgery, the parents presented with the baby for removal of sutures. There was very good approximation of the vermillion, structural appearance of the columella and nice overall appearance to the nose. She was taken to the operating room where the sutures were removed. There was very negligible scar formation and the final appearance of the baby girl was good with satisfactory functional outcome. It was explained to the parents that subsequent phased surgeries will have to be done for correction of the other defects.  

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23MarOroantral Fistula Closure Surgery

Oroantral Fistula Closure Surgery – Dr SM Balaji, Oral and Maxillofacial Surgeon, India

This patient developed an oroantral fistula after undergoing a traumatic extraction of the right maxillary second molar a few years ago in his hometown. He had already been operated a few times previously, but the fistula kept recurring. An oroantral fistula is a communication between the oral cavity and the maxillary sinus that is lined by epithelial tissue. He was referred to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai for management of his problem. Oroantral Fistula Closure Surgery Dr. S. M. Balaji examined the patient and decided to perform a palatal flap closure of his oroantral fistula. Following successful induction of general anesthesia, a palatal flap was raised, the epithelialized tissue from the fistula was excised and closure was obtained by suturing the flap over the oroantral fistula. The patient presented to Dr. Balaji a month after surgery and a nose blow test confirmed complete closure of his fistula. The patient expressed his gratitude to Dr. Balaji for solving this long standing problem, which was causing significant mental anguish for the patient.

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22MarPleomorphic Adenoma Of The Palate Excision

Pleomorphic Adenoma of the Palate Excision – Dr. S.M Balaji

This 20 year old girl reported to our hospital with the complaint of a swelling on the left side of the palate for the past 12 years. The swelling was gradually increasing in size and it became more noticeable about two years ago. Of late, she has been having difficulty swallowing food. After thorough clinical and radiological analysis, Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon provisionally diagnosed it to be a pleomorphic adenoma. Differential diagnoses for this included palatal abscesses, soft tissue tumors such as fibroma, lipoma, neurofibroma, and neurilemmoma as well as other salivary gland tumors. Pleomorphic adenoma is a benign neoplasm, which is commonly encountered in the parotid gland and other major salivary glands. Infrequently, it may arise from minor salivary glands and present as an intraoral mass over the palate or lip. Salivary gland tumors are rare and account for 2–3% of tumors occurring in the head and neck. On examination, an oval-shaped, well-circumscribed lesion that was adherent to the underlying structures was seen on the left side of the hard palate. The lesion was about 2 cm in diameter. The swelling extended from the mid-palatal area to the border of the alveolar ridge on the left side. The overlying mucosa was smooth and intact, but was stretched and shiny in comparison to the healthy area on the opposite side of the palate. There was no regional lymphadenopathy and her general physical and systemic examination was normal except for a minor thyroid hormone imbalance with TSH being elevated. With the help of 3-D axial CT scan, extension of the lesion was traced. Superiorly, it extended to the floor of the nasal cavity and its posterior extension was up to a cm anterior to the greater palatine foramen. The lesion had eroded the underlying palatal bone and was well circumscribed with clear margins. Excisional biopsy was done. Under general anesthesia, a palatal crevicular incision was made and a palatal mucosal flap was raised along with the underlying mucoperiosteum, thus exposing the lesion. The soft tissue mass was removed in toto with good clearance and it was well encapsulated and soft fibrous in texture. Following this, the palatal mucosal flap was approximated and sutured in position and the tissue obtained was sent for histopathological examination. Histopathology revealed it to be a pleomorphic adenoma of the palate. The palatal bone defect caused by erosion due to the tumor was planned to be reconstructed at a later date using auto bone graft.

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21MarBest Dental Hospital In India

Blowout Fracture – Zygomatic Orbital Complex Surgery with Open Reduction and Fixation of Zygomatic Complex

This middle aged man met with a road traffic accident with impact to the left side of his face. He had severe pain and swelling on the left side of his face and was rushed to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai by his family after first aid had been administered elsewhere. Dr. S. M. Balaji examined the patient and ordered a CT scan, which showed a comminuted fracture of his left cheekbone (zygoma) and fracture of the floor of the left orbital bone. The patient was taken to the operating room and the fracture of the zygomatic complex was approached through a vestibular incision placed in the maxillary buccal sulcus on the left side. A flap was raised and the fracture fragments were carefully stabilized and fixed using plates and screws. The fracture of the floor of the left orbit was next accessed through a transconjunctival approach. The herniated fat and orbital contents were elevated and the titanium mesh that had been adapted to the contours of the floor of the orbit was placed over the fracture site to stabilize it. The mesh was then anchored to the orbital margin using screws. The surgical sites were then closed with sutures. The patient recovered from general anesthesia without complications and was taken to his room in stable condition. Surgery Video width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen">

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19MarLip Reduction Surgery

Lip Reduction Surgery – Dr. S.M Balaji, Balaji Dental and Craniofacial Hospital

Lip Reduction Surgery The patient presented at Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, with the complaint of an excessively large lower lip. She said that she wanted it to be reduced to be proportionate to the upper lip. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, examined the patient and explained the surgical correction procedure in detail. The patient consented and was scheduled for surgery. Under general anesthesia, the portion of the lip that was to be excised was marked out carefully. Incision was then made along the markings and extended down into the submucosal region. Dissection was carried down into the deeper tissues and excess tissue was excised from the region. Once adequate removal of excess tissue was performed, the vermillion borders of the incision were approximated with sutures. At the two week postoperative visit to the hospital, the patient expressed her satisfaction at the results of the surgery. Surgery Video frameborder="0" allow="autoplay; encrypted-media" allowfullscreen>

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