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
Facial asymmetry correction- condylar hyperplasia already operated but failed, maxillary shortening, buccal fat pad transfer, malar and mandibular body augmentation surgery
Patient with failed surgery elsewhere presents for correction The patient is a young woman with failed condylar hyperplasia surgery performed elsewhere. She presented to our hospital for correctional surgery. Dr SM Balaji examined the patient and ordered detailed studies for the patient. Rib graft and buccal fat pad graft obtained from the patient Under general anesthesia, a rib graft was first harvested from the patient. Valsalva maneuver demonstrated a patent thoracic cavity. The incision was then closed with sutures. This was next followed by harvesting of a buccal fat pad graft from the right cheek. Augmentation of the mandibular body done with grafts A left sided maxillary vestibular incision was next made. The bone grafts were then shaped and fixed with screws in this region. Attention was next turned to the mandible. A mucogingivoperiosteal flap was then raised. The bone grafts were then screwed in place in the molar region. This led to adequate augmentation of the body of the mandible. Maxillary repositioning and buccal fat pad transfer performed Attention was next turned to the anterior maxillary region. An osteotomy was then performed and the maxilla repositioned with four holed plates. This was then followed by transfer of the buccal fat pad graft to the left cheek. All incisions were then closed with sutures. The patient expressed complete satisfaction with the results of the surgery before discharge. Surgery Video
Large dentigerous cyst of maxilla enucleated. Root canal treated teeth saved and defect filled with rib graft
Young boy with dentigerous cyst presents with nonvital teeth The patient is a young boy who presented with a swelling in the left anterior maxilla. Dr SM Balaji examined the patient. The teeth in the area of the swelling were nonvital. Radiograph revealed the presence of a large dentigerous cyst in that region. Treatment planning was for surgical excision of the cyst. Dentigerous cyst enucleated and teeth saved A mucogingivoperiosteal flap was first raised in the anterior maxillary region. There was a supernumerary tooth present within the dentigerous cyst. The dentigerous cyst was then enucleated and removed with care taken to save all RCT teeth. A rib graft was then harvested to fill in the bony defect. Valsalva maneuver demonstrated lack of perforation into the thoracic cavity. Bony defect filled with harvested rib graft The harvested rib graft was then cut and shaped to fit into the bony defect. The graft was then fixed with screws. The flap was then sutured back in place. Postoperative healing was uneventful. Surgery Video
Short lip correction Le Fort I impaction superior positioning surgery
Patient with prognathic maxilla and short upper lip presents for surgery This young man presented with a vertical excess of the prognathic maxilla. It resulted in the shortening of the upper lip with inability to appose the lips. This was causing social problems for the patient. He presented to our hospital for surgical correction of his problem. Treatment planning explained to the patient Dr SM Balaji examined the patient and ordered imaging studies. On cephalometric analysis, it was found that he had 7 mm vertical excess of maxillary bone. He explained the treatment plan to the patient who agreed to it. Successful Le Fort I surgery with optimal results for the patient Under general anesthesia, a Le Fort I maxillary osteotomy was performed initially. The maxilla was then disengaged from the facial bone. A 7 mm strip of maxillary bone was removed in the horizontal plane. The disengaged maxilla was then repositioned superiorly with two X-plates and screws. Occlusion was then checked and found to be perfect. The incision was then closed with sutures. The patient expressed his complete satisfaction at the results of the surgery. Surgery Video
Profile enhancement by correction of upper jaw using AMO
A 25-year-old male from Raipur reported to our hospital wanting to correct his gummy smile. He also stated that his protruding upper jaw affected his appearance. He had low self-esteem and complained of inability to close his mouth. He also wanted to enhance his looks. His parents too were anxious to correct his smile and enhance his facial appearance. Maxillofacial Surgeon Dr. SM. Balaji planned for removal of the maxillary bone. The gummy smile was corrected by Anterior Maxillary Osteotomy. Post surgery his appearance improved greatly and his parents were happy with the immediate results. He was overjoyed with the outcome as he was able to close his mouth without any difficulty.
Successful closure of alveolar cleft defect with bone graft
12 year old with cleft alveolus brought for surgical repair The parents of this 12-year-old boy brought him to our hospital. They are from northern India. He had been born with a cleft lip, palate and alveolus. He had already undergone cleft lip and palate repair elsewhere as an infant. The alveolar cleft was a very large one. This caused the parents to be very concerned about their son’s present condition. They decided to turn to the Internet for a solution. A search for the best cleft aleveolus repair surgeon led them straight to our hospital. Treatment plan presented followed by successful surgery Cleft alveolus repair specialist, Dr SM Balaji decided on the treatment plan. He planned to close the defect with a bone graft. The cleft was first packed with costochondral bone graft and fixed using screws. Successful outcome of the treatment process for the patient After three months, the maxilla will fuse into one single bone. Replacement of missing teeth and orthodontic treatment will then achieve completion of treatment. The parents were very happy with the outcome of the surgery.
Neurofibroma debulking surgery
Neurofibroma explained to be an inherited disorder Neurofibroma is a benign tumor of the nerve sheath. It arises from the peripheral nervous system. An inherited disorder, is very disfiguring and adds bulk to the affected tissues. It always results in asymmetry of the affected region. Young man with neurofibroma presents for surgery This is a young man from Thalassery. He has had this debilitating condition since childhood. His face is only affected on the right side. The right eye had also become blinded by this condition. He has undergone previous surgery elsewhere in the past for the tissue overgrowth. He has become reclusive and withdrawn because of this. The growth has recurred again to the point it interfere with his activities of daily living. His family conducted extensive enquiries with medical professionals for the best cosmetic surgeon. These enquiries led them straight to our hospital for management of his disfigurement. He will need another surgery to correct his lower lip disfigurement. The patient examined and treatment plan explained Dr SM Balaji examined the patient and explained the treatment plan. The patient was in agreement with this. Surgery is done with removal of overgrowth of excess fibrous tissue Under general anesthesia, excess neurofibromatous tissue was first retracted and then excised. The proliferation of this tissue in the lobule of his right external ear was also trimmed. This resulted in the improvement of the patient’s facial contour. After removal of adequate tissue, the incisions were then closed with sutures. The patient expressed satisfaction in the improvement of quality of life before discharge.
Successful cleft palate repair surgery with release of abnormal muscle attachment
Little girl from Cuttack presents for cleft palate surgery This is an 8-month old baby girl from Cuttack. She was born with an isolated cleft palate. Her parents were very disturbed over this. They were very worried about their first born baby girl’s condition. They searched the Internet for the cleft palate repair surgeon. This search led them to our hospital. Patient examined and surgery performed successfully Cleft palate repair specialist, Dr SM Balaji examined the patient. He then planned the surgery. He decided on cleft palate repair using the palatal pushback technique. Palatal flaps were first raised on the right and left sides. The abnormal attachments of the muscles of the palate were then detached. The muscles were next reattached in a normal position like a hammock. The nasal floor and oral parts were then closed in two layers. Positive suction test performed indicating good speech in the future Following surgery, positive suction test indicated successful palate repair surgery. The parents were very happy with the results. They expressed their gratitude before discharge from the hospital.
Bilateral Cleft Lip – Successful Primary Correction
This 3-month old baby boy was born with bilateral cleft lip and palate deformity. His parents who hail from Agartala were very troubled over his condition. Mother had difficulty feeding him and he became underweight. They decided to get the best treatment for their son. An extensive research for the best cleft lip and palate surgeon followed. This led them straight to our hospital for treatment. Cleft lip and palate deformity correction surgeon Dr SM Balaji examined the patient. He explained the treatment plan to the parents. This would be through Paul Black’s cleft repair technique. The parents were in complete agreement with the treatment plan. Following surgery, the baby’s appearance improved very much and he was able to feed well. He soon began gaining weight, much to the mother’s delight. The parents were very pleased with the results as there was minimal to no scar formation. Cleft palate correction will be at a later date.
Successful surgical correction of broad nose and long lower jaw
Patient presents for surgical correction of large nose and inability to close mouth This is a 25-year-old woman from Thrissur. She presented with complaints of a large nose and the inability to close her mouth. She also complained of speech difficulty, which affected her social life. She was also quite dissatisfied with her facial appearance. She researched the Internet for the jaw correction surgeon. Her research led her straight to our hospital. Treatment planning explained to the patient Dr SM Balaji examined the patient. He explained to her that she had a class III skeletal malocclusion and an anterior open bite. Surgery would include correction of both her complaints of malocclusion and broad nose. Successful outcome of surgical correction A bijaw surgery was first done to correct the long lower jaw and the anterior open bite. Attention was next turned to her nose. Lateral nasal cartilages were then removed. This was then followed by a Weir excision to correct her bulky nose. She was very pleased with the outcome of the surgery. She expressed her willingness to increase interaction with people after the surgery.