Unilateral Cleft Rhinoplasty Surgery
Rhinoplasty for cleft lip and palate related nasal deformity The patient is a young woman who had been born with a left sided cleft lip and palate. She underwent cleft lip repair surgery elsewhere as an infant. Past surgical history of the patient She has undergone alveolar bone grafting and orthodontic treatment here at our hospital. A LeFort 1 maxillary advancement surgery was also done here. She now presents for rhinoplasty for correction of her nasal deformity. This is her final surgery. Rib grafts used to correct the nasal deformity Under general anesthesia, Dr SM Balaji harvested two costochondral rib grafts. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Rib grafts were then crafted into the right size and shape. Following this, bilateral intranasal incisions were then made. The nasal bone was next fractured and then set right to correct the deviation in the nasal septum. The cartilaginous grafts were next positioned through the incisions and stabilized with sutures. This resulted in reestablishment of nasal symmetry. The patient and her parents were very happy with the results of the surgery. They expressed this to Dr SM Balaji before discharge from the hospital. Surgery Video
Oronasal Fistula Closure, Orbital Floor Reconstruction, Augmentation Rhinoplasty and Zygomaticus plication
Extensive fractures of the facial bones and failed treatment This young lady is in her early 20’s. She met with an automobile accident on the way back home from work. This resulted in panfacial fractures. She was first taken to a nearby hospital for first aid. Following this, she was then admitted elsewhere for repair of her facial fractures. It took around 6-8 months for her facial swelling to subside. She then realized to her dismay that fixation of her fractures showed deformity. The patient now had a degree of facial disfigurement. Initial presentation and investigations She was in distress over this. It was then that she presented to Balaji Dental and Craniofacial Hospital, Chennai. The purpose of her visit was for posttraumatic deformity correction. Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient. He next ordered extensive imaging studies including 3D axial CT scans. This revealed that she had suffered panfacial fractures. The fractures involved the nasoorbitoethmoid (NOE) complex. Fractures to the orbital floor and the palatal part of the maxilla were also seen. The NOE complex fracture had left her with a saddle nose deformity due to flattening of the nasal bridge. She also had a degree of right-sided facial nerve palsy. There was also an oronasal fistula from improper closure of the palatal fracture. Closure of her oronasal fistula and orbital floor reconstruction planning Dr. Balaji explained to her that she needed closure of the oronasal fistula first. Next would be orbital floor reconstruction and augmentation rhinoplasty using rib grafts. She would then have zygomaticus plication for correction of her residual palsy. He described the surgical process in detail to the patient. Her parents and she were in agreement with the treatment plan. The patient was then scheduled for surgery. Surgical correction of deformities using rib grafts and surgical plates Rib grafts were first obtained after successful induction of general anesthesia. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Attention was then turned to the oronasal fistula. This was then closed with a palatal rotation flap. Attention was next turned to the augmentation rhinoplasty. A graft was next placed through intranasal incisions. This corrected the patient’s saddle nose deformity. There were also no visible scars. The intranasal incisions were then closed with sutures. Following this, a gingivomucoperiosteal flap was next raised on the right side of the mandible. The plates that were screwed in place to fix the body of mandible fracture were next removed. The flap was then sutured in place. An incision was next made in the maxillary vestibular area. Dissection was then done up to the area of the zygomatic arch. An incision was then made over the old scar on the right cheek. This was to access the plate fixed on the zygoma. This plate was then removed. A rib graft was next screwed to the area of the bony defect in the zygoma through an intraoral approach. The incision over the right cheek was then closed with sutures. This was then followed by closure of the maxillary vestibular incision with sutures. Alar reduction surgery for narrowing the nostrils Following this, markings were then made on the outer alar reduction. Crescent shaped tissue wedges were next removed from bilateral ala. The ala were then sutured into their new positions. This resulted in reduction of the width of the nostrils. The patient recovered well from her surgery. She expressed her happiness at the results of the surgery before discharge. Surgery Video
Prof SM Balaji, Vice-President, International College of Continuing Dental Education, Singapore, attending the convocation at Manila, Philippines
Prof SM Balaji participates in the ICCDE convocation at 40th APDC in Manila Prof SM Balaji attended the 40th Asia Pacific Dental Conference (APDC) in Philippines. SMX Convention Center in Manila, Philippines was the venue for this conference. The Asia Pacific Dental Federation (APDF) organized this conference. Asia Pacific Regional Organization (APRO) cohosted the event. Theme was “Intensifying Professionalism in Synergy with Dental Science and Technology. The International College of Continuing Dental Education (ICCDE) also conducted its convocation here. Prof SM Balaji is Vice-President of the ICCDE. Many new members were inducted into the ICCDE. Discussions held with Prof Tsang, President, ICCDE Prof SM Balaji met with Prof Jeffrey Tsang, President, ICCDE, at the conference. They held discussions over a wide range of topics. Discussions included ways to intensify continuing dental education programs in the region. They also discussed ways to enhance professionalism in the Asia Pacific region. Prof Kathryn Kell, President, FDI, was also a key attendee at the conference. Proceedings at the APDC conference Scientific sessions conducted at the conference were a grand success. Keynote speeches and presentations included a wide variety of topics involving dentistry. All member nations were well represented in all aspects of the conference. The APDF showed robust growth in all spheres. Prof SM Balaji expressed his utmost satisfaction at the growth shown by the APDF.
Cleft Rhinoplasty Depressed Alar Cartilage Correction Surgery
Patient with collapsed left ala seeks best rhinoplasty surgeon The patient is a young woman from West Bengal. She had been born with a cleft lip and palate and had undergone repair of her cleft lip and palate as an infant. The patient has a collapsed left ala of the nose. This has led to asymmetry of her face, which she wants corrected now. Her parents searched far and wide for the best rhinoplasty surgeon in India. Their search finally led them to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Treatment plan explained to the patient Dr SM Balaji, cleft rhinoplasty surgeon, examined the patient. He ordered imaging studies to assess the patient. Once he had decided on a treatment plan, he explained it to the patient and her parents. They were in complete agreement with his treatment plan. Surgical rhinoplasty correction for collapsed left ala Under general anesthesia, cartilaginous rib grafts were first harvested from the patient. A Valsalva maneuver confirmed absence of perforation into the thoracic cavity. Attention was next turned to the maxillary bony deficiency. Two rib grafts were then crafted to fit into the deficiency. Screws were then used to fix the grafts into the areas of bony deficiency. Attention was next turned to setting right the collapsed left nasal ala. All incisions were intranasal to avoid scarring. The cartilaginous graft was then shaped to fit into the collapsed ala and then inserted into the ala. This lifted up the collapsed ala and there was restoration of facial asymmetry. All incisions were then closed with sutures. The patient and her parents expressed their complete satisfaction before final discharge.
Rhinoplasty – Depressed Nasal Bridge Elevation Surgery
The patient desires to undergo rhinoplasty surgery The patient is a young woman who has a depressed bridge of nose. She has never been happy with her nose. The patient had undergone maxillary osteotomy elsewhere a few years ago. Her surgeon at that hospital had expressed inability to perform nasal correction. She had searched for the best rhinoplasty surgeon in India. This had led her straight to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai. Treatment plan for rhinoplasty explained to patient Dr SM Balaji, nose correction specialist, examined the patient. He then ordered imaging studies for the patient. The patient still had retained plates and screws from her old osteotomy surgery. Dr. Balaji explained the treatment plan to the patient and her parents and they were in agreement. Rhinoplasty surgery Under general anesthesia, two cartilaginous rib grafts were first harvested from the patient. Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers. Attention was next turned to the retained hardware from the old surgery. The hardware was first removed through a maxillary vestibular incision. The incision was then closed with sutures. Attention was then turned to the nose. Intranasal incisions were then made. Lower nasal thirds of the alar cartilage was next excised and removed. The cartilaginous grafts were then inserted through the incision. This was then tunneled up to the bridge of the nose. The tip of the nose was next lifted up with the aid of a cartilaginous graft. This resulted in the patient getting a straight bridge of the nose with a nice nasal tip. The patient expressed satisfaction at the results of the surgery. She was then discharged from the hospital. Surgery Video
Asymmetry correction with angle of mandible reduction and masseter debulking surgery
Patient with masseter hypertrophy and excess lateral mandibular angle bone The patient is a young girl from Rajasthan. She began noticing the development of an asymmetry in her face at around 14 years of age. The right side angle of the mandible region was becoming bulkier as time went by. It reached the point where the asymmetry became too obvious to ignore. She wanted to get it corrected. A local dentist advised her that surgical correction was the only way to correct it. She and her parents researched the Internet for the best oral surgeon. Their search led them to our hospital in Chennai. They got in touch with the hospital manager who asked them to send a few photos through email. Lateral angle of mandible reduction and masseter debulking surgery Dr SM Balaji examined the photographs in detail and instructed the patient to meet him. The patient and her parents came to our hospital in Chennai. He examined the patient in detail and explained the problem. The patient had excessive thickness to the lateral angle of mandible bone. This had to be first reduced. There was also masseter muscle hypertrophy that needed to be set right. This would be by removing excessive muscle tissue. The patient and her parents were in complete agreement with the treatment plan. The patient was then scheduled for surgery. Surgical correction of masseter hypertrophy and angle reduction Under general anesthesia, an incision was first made buccal to the right lower molars. The third molar was then elevated and removed. Dissection was then carried down to the lateral angle of the mandible. A hand piece was then used to trim down the excessive cortical bone on the lateral aspect of the mandible. Attention was next turned to the masseter muscle. Excessive muscle tissue was next trimmed until symmetry of both sides was achieved. The incision was then closed with sutures. The patient expressed her happiness to Dr SM Balaji with the results of the surgery. Surgery Video:
Prof SM Balaji visited the College of Dentistry, Iowa City, Iowa, USA
Prof David Johnsen, Dean, College of Dentistry, Iowa City invited Prof SM Balaji for a tour of the college. Dr Kathryn Kell, President, FDI, who is an alumnus of the college accompanied Dr SM Balaji. They toured the college and viewed the facilities. The College of Dentistry, Iowa City is an integral part of the University of Iowa. Founded over 125 years ago, it provides advanced dental education. This includes all specialties of dentistry. Dr SM Balaji discussed patient management protocols with Prof Johnsen. Outreach programs available with the college include the award-winning Geriatric Mobile Dental Unit. Dr SM Balaji with Prof David Johnsen, Dean, College of Dentistry, Iowa Prof SM Balaji had extensive interactions with the Dean of the College of Dentistry, Iowa. Dr SM Balaji and Prof David Johnsen also held discussions on many other topics. They included implementation of clinical protocols. These were with regard to helping increasing levels of patient satisfaction. Book presentation at Galagan Auditorium, College of Dentistry, Iowa City Dr SM Balaji presented Prof Johnsen with a copy of “Clinical Cranio-maxillofacial Surgery”. This was at a function held at the Galagan Auditorium. This is a book authored by him. Prof SM Balaji and Prof Kathryn Kell expressed their happiness at their visit to Prof Johnsen, Department of Pediatric Dentistry, College of Dentistry, Iowa.
Alveolar defect grafting with bone graft material
Patient with cleft lip and palate presents for implant surgery The patient is a young man who was born with a cleft lip and cleft palate. He had undergone surgery for cleft repair as an infant. The patient has missing upper left central and lateral incisors at the region of the cleft. He is undergoing concurrent orthodontic treatment for teeth alignment. The patient wanted implants to replace the two missing teeth. A rib graft surgery failed to correct the bony deficiency in the region of the cleft. There was still inadequate bony height for placement of implants. Prof S M Balaji, Cranio-maxillofacial surgeon, decided to augment the bone with Bio-Oss. The patient and his parents were in agreement with the treatment plan. Placement of bone substitute in cleft region for implant Under general anesthesia, a mucogingival flap was first raised. The screw used to fix the rib graft was then removed. Bio-Oss bone substitute was next mixed with blood and compacted into the bony defect. The flap was then sutured closed with interrupted sutures. Treatment planning for implant placement Implant placement would be undertaken once the Bio-Oss has consolidated into solid bone.
Large Dentigerous Cyst Enucleation Surgery
Dr SM Balaji diagnoses dentigerous cyst in a little Bangladeshi boy This little boy from Bangladesh developed a swelling in the front region of the upper jaw. The swelling kept increasing in size. His worried parents brought him to India for treatment. They enquired about the best hospital to get their son treated. It was during this time that they met a dental surgeon in Kolkata. He recommended Balaji Dental and Craniofacial Hospital, Teynampet, Chennai to them. They made enquiries and presented at the hospital with their son. Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined the patient and ordered comprehensive imaging studies. A 3D axial CT scan revealed a dentigerous cyst in the anterior maxillary region. He explained the condition to the boy’s parents and advised surgical excision of the cyst. The parents consented to the plan of action and the patient was then scheduled for surgery. Surgical enucleation of the cyst by Prof SM Balaji Under general anesthesia, teeth in the region were then extracted using forceps. A mucogingival flap was then raised to the region of the anterior maxillary sulcus. The region of the dentigerous cyst was then accessed. Cyst was next enucleated completely along with the unerupted tooth inside it. The flap was then sutured closed. The patient recovered well from general anesthesia.
Zygoma Reduction Surgery for Fibrous dysplasia with protection of infraorbital nerve surgery
Presentation of fibrous dysplasia Fibrous dysplasia is a very rare disorder of the bone. The gene involved is the G-protein receptor. It is a condition where fibrous tissue replaces normal bone and marrow tissue. This results in bone that is very weak. There is also excessive proliferation of this fibrous bony tissue. This leads to increased size of the affected bone. Surgical correction is the only solution for fibrous dysplasia. A patient with fibrous dysplasia presents at Balaji Dental and Craniofacial Hospital This patient presented to Balaji Dental and Craniofacial Hospital for treatment. He had increased asymmetric growth of the right zygomatic bone. Dr S M Balaji, Craniomaxillofacial surgeon, examined the patient and ordered investigations. Biopsy revealed it to be fibrous dysplasia. He explained the condition to the patient and his treatment plan. The patient was in complete agreement with the treatment plan. Surgical correction of fibrous dysplasia Under general anesthesia, an incision was first made. This extended from the outer canthus of the right eye. Dissection was then carried down to the frontal part of the zygomatic bone. Next, a vestibular incision was then made in the right maxillary sulcus. Dissection was next carried down to the dysplastic zygomatic bone. Fibrous tissue of the zygomatic bone was next trimmed with burs and chisels. Access was through both incisions. Adequate trimming of fibrous tissue was then completed and facial symmetry restored. The incisions were then closed with sutures. Great care was always taken to preserve the infraorbital nerve. Testing of the nerve at the end of surgery revealed no neuropraxia or other signs of nerve injury. The patient expressed his happiness at the results of the surgery before discharge.