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
Vertical augmentation genioplasty, LeFort I advancement, malar augmentation, BSSO by Distraction Osteogenesis Surgery for Double Chin Correction
Patient who hated his small jaw presents to our hospital This young man from Australia never liked his retruded chin. It caused him to have a double chin. He had always wished to have a more prominent mandible. His quality of life was also affected by this. The patient had enquired all over Europe, but the costs there were prohibitive. Being a medical doctor himself, he researched the Internet for a quality oral surgeon. His Internet search led him straight to our hospital. He got in contact with our hospital manager who arranged for his travel to India. Treatment plan explained to the patient The patient met with Dr SM Balaji who obtained a detailed history from him. He was very particular that he wanted advancement through distractors. This was because he wanted to monitor for himself the changes as the distractors were activated each day. A treatment plan was then formulated and explained to the patient. His double chin would be corrected. He was then scheduled for surgery. Surgical jaw correction for treatment of double chin A rib graft was first harvested from the patient. A Valsalva maneuver demonstrated absence of any perforation into the thoracic cavity. The incision was then closed with sutures. Attention was next turned to the retrognathic mandible. A vestibular incision exposed the anterior mandibular bone. The chin was then placed forwards with a vertical augmentation genioplasty. Two L-shaped four holed plates were then used to fix the bones of the chin. The posterior mandible was then osteotomized for placement of the distractors. Mandibular distractors were then fixed with screws and tested. There was adequate function of the distractors. Bilateral inferior alveolar nerves were carefully protected during the entire procedure. Attention was then turned to the maxilla. Maxillary osteotomy with placement of bone grafts aided distractor placement. Similar distractors were also utilized here. The incisions were then closed with sutures. The distractors were in stable position. 1 mm distraction per day will be next performed until adequate advancement of jaws. The patient recovered from general anesthesia without any complications. The patient expressed his complete satisfaction with the results before discharge.
Single sitting simultaneous unilateral cleft palate and lip repair
A boy from Ladakh with unilateral cleft lip and palate The patient is a 10-month-old boy with unilateral cleft lip and palate deformity. He lives with his parents in Leh. His family is from a pastoral background. A Good Samaritan from Delhi happened on this little boy during a trek in Ladakh. He offered to help the child and the parents accepted his help. The Good Samaritan did extensive Internet research. This was to find the best cleft lip and palate surgeon who could perform a total cleft repair in one sitting. His search led him straight to our hospital. Treatment planning for simultaneous cleft lip and palate repair Dr SM Balaji examined the patient and ordered imaging studies. He explained to the parents that both cleft lip and repair would undergo surgery. He undertook the surgery after detailed presurgical planning. Simultaneous cleft lip and palate repair surgery performed Under general anesthesia, cleft palate repair was first undertaken. Bilateral palatal flaps were first raised based on the greater palatine vessels. The Levator palatine muscles were then detached from their abnormal positions. These were then reattached into normal position like a hammock. A two layer closure was then done. The nasal floor was first closed in a separate layer with the vomerine flap making a reverse knot. Oral layer was then sutured by vertical mattress sutures. The vertical mattress sutures produce a ridge of thick mucoperiosteum. Flaps were then approximated to each other in the midline. This technique repositions the levator muscle in a more favorable position. Greater palatine osteotomy was then done to mobilize the artery. This was from the greater palatine canal. The suction test performed at the end showed good results. Unilateral cleft lip repair was then performed with the modified Millard’s technique. This resulted in a very good lip seal producing good esthetic results. Parents satisfied with very good surgical results The parents expressed their immense gratitude before discharge from the hospital. Surgery Video
Upper jaw Advancement Surgery Unilateral Cleft Hypoplasia – Lefort 1 Advancement Surgery
Patient presents for maxillary advancement surgery This young lady had been born with a unilateral cleft lip and palate. She had undergone cleft lip repair at our hospital at the age of 2 months. Cleft palate repair was later performed at the age of 10 months. After this, she had rhBMP-2 surgery for uniting the two pieces of the maxilla into one single bone. The patient now has a hypoplastic retruded maxilla with anterior crossbite. This had been causing her cosmetic problems with a deficient upper jaw. She wanted to have this corrected through surgery. The patient has also been undergoing fixed orthodontic treatment for cosmetic teeth alignment. Le Fort 1 maxillary osteotomy planned for the patient Dr SM Balaji is a renowned cleft lip and palate patient rehabilitation specialist. He decided to perform a LeFort 1 osteotomy with maxillary advancement for the patient. Complete correction of the patient’s crossbite occlusion Under general anesthesia, a mucogingivoperiosteal flap was first raised in the maxilla. A LeFort 1 osteotomy was then performed. The maxillary bone was then advanced by 2 cm. It was then stabilized in place with four L-shaped four-holed plates. Occlusion was then checked and deemed to be in perfect alignment. The mucogingivoperiosteal flap was then sutured back in place. She would need further fixed orthodontic treatment to perfect her teeth alignment. Postoperative period was uneventful. The patient expressed her happiness at the results of the surgery before discharge.