Successful mandibular reconstruction for a boy with Trabecular juvenile ossifying fibroma
This is a 10-year-old boy from Vadodara. He presented to our hospital with a large swelling on the right side of the face. This was first diagnosed as a ‘cyst’ elsewhere. He had already undergone enucleation of the cyst, but that surgery was unsuccessful. His father stated that the swelling returned with an increase in size and caused a great deal of pain. The parents were very worried about his future due to recurrence. His parents had searched the Internet for the facial deformity correction surgeon. Their search had led them straight to our hospital. Dr SM Balaji examined the patient. Radiographic investigations obtained at our hospital showed a mixed radiolucent and radiopaque lesion. This lesion was extending from the right ramus to the body of the mandible. It had a ground glass appearance. Histopathological examination confirmed it to be trabecular juvenile ossifying fibroma. Treatment planned for the patient included a right hemimandibulectomy. The parents were in complete agreement with the proposed treatment. Resection of fibroma was first done followed by a right hemimandibulectomy. The defect was then reconstructed using a mandibular reconstruction plate and costochondral grafts. This resulted in symmetry of the patient’s face. The parents were very happy with the outcome of the surgery.
Successful OKC resection and jaw reconstruction
This is a 32-year-old man from Palakkad. He complained of severe pain and swelling in his lower jaw. He also complained of difficulty opening his mouth and chewing food. He has been suffering from this condition for about four years now. He searched the Internet for the best jaw correction surgeon. His search led him straight to our hospital. Dr SM Balaji examined the patient. He recommended comprehensive testing for the patient. Clinical, radiological and histopathological examinations were then performed. This led to the diagnosis of an odontogenic keratocyst. There was complete obliteration of the mandibular body. Treatment plan included complete cyst resection and reconstruction of the lower jaw. This would be by utilizing costochondral grafts. The affected area of the lower jaw was then removed. This was along with the involved tooth to ensure zero recurrence. The costochondral rib grafts were then used to reconstruct the lower jaw. Titanium screws and plates helped achieve stable fixation of the grafts . The patient was very happy with the outcome of the surgery. There was no scar as all incisions were intraoral.
Deviated nose correction with cc graft
This is a 30-year-old male from Belagavi. He was involved in a road traffic accident. This resulted in a blocked nose with difficulty breathing. He had undergone a nose block clearance surgery elsewhere by open rhinoplasty. This resulted in him developing a deviated nose. There was also residual scars over the bridge of the nose and the columella. He was very dissatisfied with this and desired corrective surgery. He searched the Internet for the best nose deformity correction surgeon. This led him straight to our hospital. Dr SM Balaji examined the patient. The patient explained his problem. He said he had great difficulty breathing and that he wished for a more prominent nose. He agreed to the proposed treatment plan. Surgical correction would be through the use of a costochondral rib graft. The nasal deviation was first corrected by a right lateral osteotomy. The nasal bridge height was then increased. This was by using the graft harvested from the right inframammary region. A small piece of the tissue was next excised from the right supra-alar crease to lift up the right nostril. The results were immediate and the patient was very satisfied with the results. He expressed his gratitude before discharge from the hospital.
Improving facial profile by Masseter reduction
A 32-year-old male reported to our hospital with a complaint of square face. He was very unhappy with his facial appearance and requested for immediate correction of the same. Maxillofacial surgeon Dr. S.M.Balaji diagnosed it as bilateral masseter muscle hypertrophy. The Masseter muscle was partially excised bilaterally. The angle of the mandible on either side was also burred down. The lower jaw appeared more proportionate. He was pleased with the overall results and there was no scar formation as the entire procedure was done intra-orally.
Depressed nose correction by closed rhinoplasty
A 25-year-old girl reported to our hospital with complaints of depressed nose and asymmetrical upper lip. She was very unhappy with the shape of her nose and said that it affected her facial appearance. Maxillofacial Surgeon Dr. S.M.Balaji planned to correct her nose using cc graft. Rib cartilage graft was harvested from the 8th intercoastal rib. The nasal bridge was augmented with cc graft. The left side of the nose was elevated using the cc graft as a strut graft. The lip revision was also done using Modified Millard’s technique. Results were immediate and the patient was very pleased with her new looks. This dramatically improved her appearance and helped regain her confidence.
Successful surgical correction of diplopia and depressed zygoma
This is a 23-year-old male from Nagpur. He presented with complaints of diplopia in his right eye and a depression on the right side of the face. He has a history of RTA with emergent treatment of zygomaticomaxillary complex fracture. He was not happy with the outcome of the surgery. His diplopia had not been corrected by the surgery. He then searched the net for the best facial deformity correction surgeon. His search led him straight to our hospital. Dr SM Balaji examined the patient. The patient had diplopia of the right eye. The diplopia was present only at the extremities of gaze. A 3D CT scan revealed a depressed and malunited right zygoma. Maxillofacial Surgeon Dr SM Balaji planned the treatment. He planned to correct the depression by refracturing the zygoma. The right malunited zygoma was first exposed by a vestibular approach. The right zygoma was then refractured, elevated and fixed using Ti. plates and screws. The right orbital floor was then reconstructed with a Titan Medpor mesh. This was also fixed using titanium screws. He was very happy with the results of the surgery.
Successful correction of left side facial asymmetry due to RTA
This is a 33-year-old male patient from Siliguri. He met with an accident about three months ago. He underwent emergent treatment at a nearby local hospital. He realized that the accident had left him with a left sided double vision. He underwent three surgeries for his double vision, but this persisted. A depressed fracture of his left eyebrow and maxilla had left him with facial asymmetry. None of these issues were set right by the three surgeries. The oral surgeon who operated on him referred him to our hospital. He told the patient that all his problems would be set right. He presented for consultation. Dr SM Balaji examined him and recommended a 3D CT scan. This revealed a malunited zygomaticomaxillary complex fracture. The treatment plan was then explained to the patient. This would involve the use of a costochondral bone graft. A costochondral bone graft was first harvested from the sixth intercostal rib. Reconstruction of the lateral wall of orbit and orbital floor was then done with a Titan Medpor mesh. This corrected the diplopia and enophthalmos. The left zygomatic arch was then refractured and pushed inwards. Attention then turned to the left maxillary defect and depression in the left eyebrow. This was by using a costochondral bone graft, which was then fixed using titanium screws. The deviated left nasal bridge was then corrected using lateral osteotomy. The patient was very satisfied with the results of the surgery.
Primary lip repair for unilateral cleft lip and palate
Baby girl with unilateral cleft lip and palate presents for surgery This is a 3-month old baby girl from Guwahati born with a unilateral cleft lip and palate. Her parents were very disturbed over this. They decided to search the Internet for the best cleft lip and palate repair surgeon. This brought them straight to our hospital seeking treatment for her cleft deformity. They expressed their anxieties over their daughter’s condition. Patient examined and surgical plan presented to parents Cleft lip and palate repair specialist Dr SM Balaji examined the patient. His decision was to perform the modified Millard’s technique. The parents were in complete agreement with his treatment plan. Successful surgical correction of cleft lip Surgery for the little girl was a resounding success. Following surgery, she looked like any other baby girl of her age with minimal to no scar. The parents were very pleased with the results. Cleft palate correction surgery will be at a later date.
Facial Feminization – Bimaxillary setback, Gonial angle Reduction, Masseter Reduction and Advancement Genioplasty
Young man desiring facial feminization surgery The patient is a young man who presented to our hospital for facial feminization surgery. He had zeroed in on our hospital after extensive Internet research. Dr SM Balaji is a member of the W-PATH. This organization dedicates all its efforts toward improving transgender healthcare. It aims to provide accessible healthcare for persons with different gender identities. The patient had a hypertrophic masseter. Diagnostic studies performed for treatment planning A 3D axial CT was first obtained for treatment planning. This planning proceeded after obtaining his biometrics. The patient agreed to the treatment plan and was then scheduled for surgery. Facial feminization surgery with good esthetic results Under general anesthesia, a right mandibular vestibular incision was first made. The bone at the gonial angle was then reduced to reduce its prominence. Excess masseter muscle was then excised and removed. The same procedure was then performed on the left side with symmetrical results. Bimaxillary setback surgery was then performed through an osteotomy of the maxillary bone. Advancement genioplasty was next performed. Osteotomy was then performed with good cosmetic results. Occlusion was perfect at the end of the two procedures. All incisions were then sutured close. The patient expressed his satisfaction at the results before final discharge.
Mandibular Prognathism BSSO (Bilateral Sagittal Split Osteotomy) With Separation of Inferior Alveolar Nerve
Patient with prognathic mandible presents for surgery This young man always had a very prominent mandible. He had always hated it and wanted it corrected. This had also been a source of difficulty with eating due to malocclusion. He decided to get this treated and turned to the Internet. He researched the Internet for the best jaw correction surgeon. His search led him directly to our hospital. Treatment planning explained to the patient Dr SM Balaji examined the patient and ordered diagnostic studies. He explained his treatment plan to the patient. The surgical plan was to perform an Obwegeser’s bilateral sagittal split osteotomy. This would set back the lower jaw. Complete correction achieved with surgery with no scarring Under general anesthesia, incisions were first placed in the retromolar area. The bone in this area was then exposed. Osteotomy cuts were next placed taking care to protect the inferior alveolar nerve. The position of the teeth and the amount of setback required was also kept in mind. Bilateral sagittal split osteotomy was then performed. Excess bone was then removed and correct occlusion achieved. The bony segments were then stabilized using titanium plates. Incisions were then closed with sutures. This procedure was done on both sides. The entire procedure was intraoral with no residual scarring. The patient expressed his satisfaction at the results of the surgery before discharge. Surgery Video