Unilateral Cleft Maxillary (Upper jaw) advancement. LeFort I Osteotomy with Dental Implant Surgery
The patient is a young woman who had been born with a unilateral right sided cleft lip and palate. She had undergone cleft lip repair as a 2-month infant at Balaji Dental and Craniofacial Hospital. Second surgery was for repair of cleft palate. Stage 3 surgery involved the placement of a bone graft for closure of her alveolar bone cleft. The patient now presents for a LeFort I osteotomy for advancement of her retruded maxilla and for placement of implants for replacement of her missing maxillary teeth. An implant was first placed for replacement of her right maxillary canine. This was then followed by placement of an implant for replacement of her missing first molar. Attention was next turned towards the LeFort I osteotomy of her maxilla. A gingival mucoperiosteal flap was first raised up to the buccal sulcus. A LeFort I osteotomy was then performed. The entire maxilla was then advanced by 2-3 mm. This resulted in establishment of a Class I occlusion along with correction of her anterior crossbite. The maxillary segment was then stabilized in position with the use of three plates with four screws to each plate. This would aid in stability of her plates during the healing period. Her occlusion was then checked and the teeth were found to be in perfect alignment. The flap was then sutured in place. She recovered well from general anesthesia and was in stable condition. The patient was very happy with the results of the surgery and expressed the same to Dr SM Balaji. Surgery Video
Comminuted zygoma fracture reduction and relief of infraorbital nerve compression
Facial numbness due to nerve entrapment in fracture fragments This young man fell down a flight of stairs and ended up with pain and swelling on the left side of his face. He was experiencing numbness in the infraorbital region for the last three months. He came to our hospital to address this. Dr SM Balaji, oral and maxillofacial surgeon, examined the patient. Then he ordered a 3-D axial CT scan for the patient. It revealed the infraorbital numbness was due to nerve entrapment in the fracture. Treatment plan was then explained to the patient. He was in complete agreement with the proposed treatment plan. Surgical correction with release of entrapped nerve The patient underwent uneventful induction of general anesthesia. A left maxillary vestibular incision was first made to visualize the fracture site. This revealed the comminuted zygomatic fracture. There was a fracture fragment that was rotated in the medial direction. This was first elevated and fixed with plates and screws. The entrapped infraorbital nerve was then released from the fracture. This resulted in perfect alignment of the various segments of the fracture. The maxillary vestibular incision was then closed with sutures. The patient expressed his gratitude before discharge from the hospital.
Cleft Orthognathic Surgery, LeFort I Advancement for Bilateral Cleft Lip and palate Surgery
Young Nepali girl with extreme crossbite of the jaws This teenage girl from Kathmandu, Nepal was born with a bilateral cleft lip and palate. Her parents brought her to our hospital for correction of her deformities. She had undergone cleft lip repair at two months of age and cleft palate surgery at 10 months of age. She had surgery with rhBMP-2 for repair of her cleft alveolar bone at 4-1/2 years. This was to repair and unite the maxilla, which was in three segments. She had developed an anterior crossbite due to deficient growth of the maxilla. As a result, she has had difficulty with eating and speech all her life because of her crossbite. Her parents decided to get her problem corrected through surgery. They then brought her back again to our hospital for correction of her problem. Treatment planning for crossbite correction Prof SM Balaji, Cranio-maxillofacial surgeon, examined the patient. The patient was very familiar to him as he was her surgeon since her infancy. He ordered a 3D axial CT scan and other pertinent studies. Once he had decided on the treatment plan, he explained it to the parents and the patient. They were in complete agreement with his plan of treatment. Surgical correction of the patient’s crossbite A maxillary vestibular incision was first made after induction of general anesthesia. A maxillary osteotomy was then performed. The osteotomized maxilla was then advanced forwards to correct the anterior crossbite. This was done utilizing two plates on each side with four screws per plate. It was for stabilizing the maxillary bone during the healing period. The bite was then checked and there was complete correction of the crossbite. Incisions were then closed with sutures. The patient expressed complete satisfaction with the results of the surgery. Surgery Video
Prof SM Balaji delivers a guest lecture at Makati Medical Centre, Manila, Philippines
Makati Medical Centre Makati Medical Centre is a premium multispecialty hospital in Manila, Philippines. It is a 600-bed hospital where world class treatment is available for all. It has a Section of Oral and Maxillofacial Surgery. This is headed by the eminent Prof Ted Nicoloff. Residents here deal with a variety of complicated cases daily. Surgical training here include treatment and rehabilitation of patients with cranio-maxillofacial abnormalities. Prof Balaji’s guest lecture at MakatiMed Prof SM Balaji was invited by Prof Ted Nicoloff, Head, Section of Oral and Maxillofacial Surgery to MakatiMed. He delivered a special guest lecture on the ‘Management of Craniofacial Clefts.’ Prof SM Balaji’s is one of the leading Cranio-Maxillofacial Surgeons in the world today. The Craniofacial Foundation of the Philippines organized this. Also involved were St Jude Hospital and Mary Chiles General Hospital. Prof SM Balaji delved in depth into the subject of Craniofacial Clefts. He has rehabilitated many children with complex craniofacial clefts over a period of 27 years now. Interactive session at the completion of Prof SM Balaji’s lecture The post lecture question and answer session was very interactive. Prof SM Balaji fielded all the questions with aplomb. This had his characteristic mix of brevity and humor. The staff and residents of Oral and Maxillofacial Surgery applauded Prof SM Balaji’s lecture. Prof SM Balaji held discussions with Dr Charles P Sia and Dr Ted Nicoloff. They discussed ways to improve delivery of craniofacial treatment to patients throughout Philippines.
Cosmetic Rhinoplasty – Nasal Bridge Augmentation & Alar Base Reduction Surgery
Searching for the best rhinoplasty surgeon in India The patient is a young woman who always wanted a sharp nose with a straight bridge. She had always felt that her nostrils were too wide for her face. A doctor in her hometown suggested that she undergo rhinoplasty. She and her parents searched for the best rhinoplasty surgeon in India. They finally decided to come to our hospital for surgery. Treatment plan explained to the patient Dr SM Balaji, Rhinoplasty specialist, examined the patient upon arrival at the hospital. He explained to the patient and her parents that she needed a rib graft. The patient and her parents were in agreement with the treatment plan proposed by him. Rhinoplasty procedure performed on the patient Under adequate general anesthesia, a rib graft was first obtained from the patient. A Valsalva test was then performed to confirm that there was no perforation of the thorax. Attention was next turned to the nose. An intranasal incision ensure that there would be no external scar formation. The bone graft was then tunnelled through the incision to lift up the bridge of the nose. Alar reduction was then performed to reduce the width of the patient’s nostrils. The patient and her parents expressed their happiness at the results of the surgery.
FDI Education Committee and ADA Advisory Committee midyear meeting at Cedar Rapids, Iowa
The World Dental Federation The World Dental Federation (FDI) came into being in 1900. It serves as the representative for over a million dentists worldwide. FDI formulates protocol for enabling the advancement of dentistry. It also makes these advancements accessible to dentists worldwide. FDI organizes worldwide campaigns for oral health. These educate people about the importance of oral health. The FDI also upgrades the quality of dental education. It serves to maintain standards of dental institutions around the world. FDI Education Committee Midyear meeting at Cedar Rapids, USA The FDI Education Committee is an elected body of peers. Members have made significant contributions in the field of dental education. They meet at a midyear meeting every year. This is to discuss ways of improving the delivery of dental education worldwide. The Education Committee Midyear Meeting this year was held at Cedar Rapids, Iowa. Representatives of the American Dental Association Advisory Committee also attended this year’s meeting. FDI staff was also present at the meeting. Dr SM Balaji provides valuable inputs at the Education Committee meeting The committee meeting chair was Dr. Jurgen Fedderwitz. Vice chair was Dr. Hande Sar Sancakli. Dr. SM Balaji participated in the Education Committee meeting. He proposed innovative ways to enhance dental education worldwide. It particularly included developing countries. Dr. William Cheung, Dr. Hiroyuki Nakano and Dr. Marzena Dominiak were also present. Members of the American Dental Association Advisory Committee also attended the meeting. They included Dr. Roger Macias, Dr. Ken McDougall and Dr. Nanette Tertel. FDI Executive Council Luncheon Meeting Dr SM Balaji also attended a luncheon meet organized here. Others at the luncheon included Dr Kathryn Kell, President, FDI, Dr Nikolai Sharkov Council Member, FDI, Dr Harry Sam-Selikowitz, Science Committee Chair and Dr Gerhard Seeberger, President-Elect
Unilateral Cleft Lip and Palate Rhinoplasty
The patient presents for rhinoplasty This young child was born with a right sided cleft lip and palate. She had undergone corrective surgery of her cleft lip as an infant. She now presents for rhinoplasty for correction of her nasal deformity. Surgical correction utilizing rib grafts Under general anesthesia, an incision was first made. A rib graft was then harvested from the patient. Valsalva maneuver demonstrated patency of the thoracic cavity. The incision was then closed in layers. The graft was then crafted for use as a strut graft and an alar cartilaginous graft. Attention was next directed towards the nose. Intranasal incisions were then made to avoid scar formation. The cartilaginous graft was then tunneled into position and stabilized with sutures. Scar revision and alar skin removal procedure Attention was next turned to the scar from the old cleft lip surgery. Scar tissue was first marked and then removed. A small strip of tissue was then incised and removed from the outer aspect of left alar region. This was then closed with sutures. The procedure resulted in establishment of symmetry of the nostrils. Surgery Video
RTA-Multiple Surgeries with Pseudarthrosis Re-surgery and Bone Grafting
Pseudarthrosis of mandibular fracture after many surgeries post RTA This patient ended up with a horrific fracture to his mandible after a RTA(Road Traffic Accident). He has had four surgeries elsewhere in attempts to correct this. Reconstruction plates used did not heal the fracture site. Each surgery had only led to further worsening of his condition. He ended up with shortening of his mandible on the left side with associated numbness of lip. There was a 2-inch gap at the fracture site with nonunion of his mandibular fracture. The wound had a chronic infection with formation of granulation tissue. This had led to pseudarthrosis and asymmetry of his face. The patient was feeling very frustrated and hopeless with his situation. He could not even eat well because of the malocclusion. Determined to do something about this, he turned to the Internet. He did extensive Internet research for the best maxillofacial surgeon. This led him straight to our hospital for surgical correction. Patient presents for correction of nonunited fracture Dr SM Balaji examined the patient and ordered extensive imaging studies. He explained to the patient that he needed bone grafting for his 2-inch mandibular defect. The patient was in agreement with this treatment plan. Surgical correction of nonunited left mandibular fracture After adequate general anesthesia, the preexisting lower archbar was first removed. IMF done with stainless steel wires stabilized the jaws in correct anatomical position. A left sided gingivomucoperiosteal flap was then raised. The flap was then reflected to expose the region of the fracture. There was a 2-inch bony gap with complete nonunion of the fracture. Presence of granulation tissue was also noted. The old titanium plate was then unscrewed and removed. This was next replaced with a thinner new titanium plate. Granulation tissue was then removed. A rib graft was then harvested from the thoracic region. Following this, a Valsalva test demonstrated thoracic patency. This incision was next closed with subcuticular sutures. Stabilization of the fracture segments The rib graft was then sectioned to fit into the nonunited fracture site with miniplates. Rib graft pieces were then positioned at the nonunion site and screwed in place. Use of miniplates achieved this. This would ensure complete union of the fractured mandibular bone. The flap was then closed with sutures. Occlusion reestablished for the patient Occlusion was then checked and found to be perfect. Intermaxillary fixation was then released. The patient expressed his happiness at the results before discharge.He presented the hospital with a glowing handwritten testimonial about his experience here. Testimonial Surgery Video
Infected Dentigerous Cyst, Complete Enucleation and Alveolar Bone Reconstruction with Rib Graft
An introduction to dentigerous cysts and their etiology A dentigerous cyst forms around the crown of buried or unerupted teeth. They are most often found in relation to mandibular third molars. These teeth are the ones that are most often found impacted. Accidental discovery is the common with dentigerous cysts. This happens when x-rays taken for other mundane issues reveal their presence. They sometimes become infected and cause pain or swelling, leading to their discovery. Young man with long standing pain presents for treatment This young man developed pain in the right posterior mandibular region. He then presented to our hospital for treatment. Radiographs and 3-D axial CT scans were first obtained. These showed a bony lesion in the right mandibular ramus and third molar region. A biopsy showed it to be an infected dentigerous cyst. Dr SM Balaji, Cranio-maxillofacial surgeon formulated a treatment plan. This was to enucleate the dentigerous cyst. Reconstruction of the ramus would follow with rib grafts. The patient agreed to surgery and was then taken to the operating room. Dentigerous cyst removal surgery Under general anesthesia, a rib graft was first harvested. A Valsalva maneuver was then performed before closure of incision. This was to ensure that there was no perforation into the pleural cavity. A sulcular incision was then made in the right mandibular posterior region. This was next followed by raising a gingivomucoperiosteal flap to expose the lesion. The dentigerous cyst was then completely enucleated and the entire cyst lining removed. The involved region of the jaw was then reconstructed using the rib graft. Sutures were then used to close the incision. The patient made a complete recovery from the surgery before discharge home. Surgery Video
Long standing facial paralysis static suspension of orbicularis oris fascia Lata Surgery
Young man with facial paralysis presents for treatment This young man presented at our hospital for treatment. He is suffering from long standing facial paralysis. Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient. He explained the treatment process to the patient. This would involve surgical correction to restore actions of facial expression. The patient was also counseled about the extent of possible correction. A strip of fascia from the vastus lateralis muscle of the thigh would be harvested for this purpose. He expressed understanding of the procedure and gave consent for the surgery. He was then scheduled for surgery. Facial expression reestablished with fascia lata graft A nasolabial incision was first made and the orbicularis oris muscle exposed. A preauricular stab incision was first made. Then the harvested strip of fascia lata was tunneled to the orbicularis oris muscle. The orbicularis oris muscle was then overlaid on the fascia, which was then sutured to the muscle. This incision was then closed with sutures. The other end was then sutured to the region of the preauricular stab incision, which was then closed. The patient tolerated this procedure well and recovered from general anesthesia.