Infected dentigerous cyst – Resection and reconstruction

Infected dentigerous cyst – Resection and reconstruction

Jaw Reconstruction Surgery for Infected Dentigerous Cyst

The lower half of the face comprises the upper jaw and the lower jaw. They aid in speech, eating, and communication. The jaws comprise bones, mucous membranes, nerves, arteries, veins, glands, and other specialized cells. They can be affected by pathological entities such as infected dentigerous cysts and odontogenic keratocysts.

Jaw reconstruction surgery is the preferred treatment for jaws with residual deformities from pathologies. Loss of bone from the jaws can result from a variety of conditions. They can be from trauma, cysts and cancers. Jaw reconstruction surgery enables restoration of both function and esthetics for the affected jaws.

Various Cystic Lesions of the Jaws including Infected Dentigerous Cyst

The dentigerous cyst is the most common odontogenic cyst of the jaws. It is always associated with an impacted tooth. An infected dentigerous cyst is manifested by pain and swelling of the affected region of the jaw. Complete enucleation of the cyst followed by jaw reconstruction surgery is the treatment of choice for this pathology.

Dentigerous cysts are most commonly associated with impacted mandibular third molars. The next most common site of occurrence is with impacted mandibular canines. They can however occur with any impacted tooth. There have been instances where dentigerous cysts have occurred in association with odontomes.

What are Odontogenic Cysts and how do they arise?

Odontogenic cysts are cysts that arise in the jaw from cells that aid in tooth development. They comprise a sac with a distinct membranous lining. They may contain air, liquids or solids. Infected dentigerous cysts have an impacted tooth within them.

The most common odontogenic cysts are radicular cysts. These are followed by dentigerous cysts. Infected dentigerous cysts are often painful and are accompanied by swelling. The next most common cysts are odontogenic keratocysts followed by periodontal cysts. They all commonly result in the destruction of the jaw bone.

Jaw Reconstruction Surgery and Facial Plastic Surgery

Jaw reconstruction surgery is the treatment of choice for the rehabilitation of these patients. This is followed by dental implant surgery to aid in the restoration of function. Jaw reconstruction is a form of facial plastic surgery. Facial plastic surgery involves the restoration of facial deformities. Experienced surgeons provide the best results for facial plastic surgery.

Patients can have jaw deformities due to a variety of reasons. They can be congenital as in cleft palate deformity or can arise due to road accidents. They can also arise due to conditions such as hemifacial microsomia. Jaw reconstruction surgery can be performed through processes such as distraction osteogenesis or usage of bone grafts.

Dental implant surgery is the final step in the rehabilitation of patients who undergo jaw reconstruction surgery. This form of facial plastic surgery not only restores function but also facial esthetics. Dental implant surgery is followed by the fixation of esthetic ceramic crowns to complete the rehabilitation process.

Premier Center for Facial Plastic Surgery in India

Our hospital is a renowned center for facial plastic surgery. We have been rehabilitating patients with facial deformities for over 30 years now. Located centrally in Chennai, which is the capital city of Tamil Nadu, India, we offer excellent results from facial reconstruction surgery.

The patient develops Swelling in Anterior Lower Jaw Region

The patient is a 28-year-old female from Gudur in Telangana, India. She noticed a swelling with pain in the anterior lower jaw at the region of the incisors and canine. As this was progressively increasing, she visited a dental clinic for consultation. Imaging studies were obtained and revealed a retained deciduous canine and an impacted permanent canine.

There was also radiolucency around the crown of the impacted canine. Suspecting this to be a dentigerous cyst, the patient was referred to our hospital for management. She was diagnosed with an infected dentigerous cyst associated with the impacted canine.

Initial Visit at our Hospital for Management of her Infected Dentigerous Cyst

Dr. SM Balaji, Jaw Reconstruction Surgeon, examined the patient and ordered imaging studies and biopsies. This returned with the diagnosis of an infected dentigerous cyst. Treatment planning was explained to include harvesting of bone grafts and dental implant surgery. The patient expressed understanding and consented to surgery.

Rib bone grafts were first harvested from the patient. This was followed by enucleation of the dentigerous cyst along with the impacted canine tooth. Teeth overlying the dentigerous cyst were also extracted. The resultant bony defect was reconstructed using rib graft and titanium screws.

Instructions to Return in Four Months for Dental Implant Surgery

Instructions were given to the patient to return in four months. This would allow for the complete consolidation of the bone grafts with the surrounding alveolar bone. She returned in four months as instructed for dental implant surgery. Dental implants were placed in her reconstructed jaw as per protocol. She was then instructed to return in four months’ time for ceramic crowns. This would allow for osseointegration of the dental implants to the surrounding bone.

The patient and her family were extremely happy with the level of care at our hospital. She expressed understanding of the instructions and will return in four months for her ceramic crowns.

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Reconstruction of upper jaw with Rib Graft

Reconstruction of upper jaw with Rib Graft

Importance of Jaw Reconstruction surgery following Trauma

The jaws play a very important role in the maintenance of overall good physical and mental health. They give form to both the middle face and the lower face. Good symmetrical jaw structure plays a vital role in the holistic well-being of the person. They not only aid in speech and eating but are also vital for the esthetics of the facial region.

When this balance is disrupted either through disease or trauma, reconstructive surgery helps in reestablishing normalcy. Reconstruction of the upper jaw and lower jaw are exacting surgeries, which require a high level of skill. Experienced facial plastic surgeons provide the best results for jaw reconstruction surgery.

Role of Oral and Maxillofacial Surgeons in Facial Plastic Surgery

Oral and maxillofacial surgeons specialize in surgeries of the maxillofacial complex. They undergo a specialized training that involves cosmetic, trauma and cancer surgeries. Facial plastic surgery is also performed by them. Experienced surgeons of this specialty obtain the best results from jaw reconstruction surgery.

Treatment Modalities in Jaw Reconstruction Surgery

Various treatment modalities have been developed over the years for performing jaw reconstruction surgery. They include the usage of bone grafts and rh-BMP2, distraction osteogenesis, Le Fort osteotomies and sagittal split osteotomies. The best surgeons are able to visualize the final results beforehand and plan the surgeries accordingly.

Conditions that Require Jaw Reconstruction Surgery

Jaw structure can be compromised due to a variety of factors. They include pathological, trauma and developmental. All these causes lead to a compromise in the overall quality of life for the patient. Modern surgical techniques have advanced to the point where the compromised jaw structure can be corrected through jaw reconstruction surgery.

Bilateral sagittal split osteotomy is performed for the receded lower jaw. Correction of craniofacial anomalies including orthognathic surgery is performed by Craniofacial surgeons. Cleft palate repair and cleft lip repair are performed by facial cosmetic surgeons. These are congenital defects present at birth.

Mandibular osteotomy is performed to reduce an oversized lower jaw. This is a form of corrective jaw surgery. Surgery is performed through small incisions made intraorally. Many of these cases require orthodontic treatment before and after surgery for fine-tuning of occlusion. Plates and screws are used to stabilize the site of the osteotomy.

Many pathological processes lead to compromise in the structure of the jaws. The tumours and cysts like ameloblastoma, odontogenic keratocysts, dentigerous cysts and osteosarcomas. Conditions such as hemifacial microsomia, congenital micrognathia and fractures caused by trauma also lead to jaw deformities.

Jaw Reconstruction Surgery as a part of Facial Plastic Surgery

Jaw reconstruction surgery is only one aspect of facial plastic surgery. Rhinoplasty, scar revision surgery, microtia surgery, facial asymmetry surgery and facial reanimation surgery also form a part of facial plastic surgery. All these surgeries are technique sensitive and take years of dedication and hard work to master.

Medical Tourism Destination for Jaw Reconstruction Surgery

Our hospital is a premiere center for facial plastic surgery in India. We are a super specialty surgical center for jaw reconstruction surgery. Our hospital has been a destination of choice for patients coming for facial surgery from around the world. We offer world-class services at a very nominal cost compared to hospitals in the developed nations.

Our hospital has won numerous awards for providing good results consistently for over three decades now. We are the affiliate surgery center for many international foundations around the world. This has been made possible by the dedication and hard work of Dr. SM Balaji. It is the result of his vision to provide world-class treatment in a third-world setting.

Extensive Facial Deformities due to Road Traffic Accident

The patient is a 36-year-old male from Raipur in Chattisgarh, India. He was involved in a horrific multivehicle road traffic accident a few years ago. This resulted in extensive panfacial fractures, which left him with extensive facial deformities and functional compromise. He had suffered frontal, orbital, zygomatic, maxillary, and mandibular fractures.

He has undergone multiple surgeries in several hospitals in the past, but none of these surgeries were successful. They had resulted in worsening of his functional difficulties and facial esthetics. He had subsequently become depressed as the surgeries only compounded the problems caused by the road traffic accident.

Referral to our Hospital for Surgical Management of Facial Deformities

Realizing that the problem had to be addressed, his family conducted extensive inquiries for the best hospital to treat him. Many of the doctors they contacted referred them to our hospital. Convinced that our hospital was the best surgical center to address his problems, they presented to our hospital for an initial consultation

The treatment plan for surgical management of facial deformities caused by the previous surgeries was presented to them. It was explained that this would involve multiple surgeries that had to be spaced to obtain the best results. They were informed that the first surgery would be maxillary reconstruction using rib grafts harvested at the time of surgery.

Successful Reconstruction of Maxilla with Rib Grafts

He underwent successful reconstruction of the maxilla using rib grafts that were crafted to reconstruct the bony defect. There was a complete failure of the rib graft that had previously been placed in his hometown. The new rib grafts resulted in symmetry with the contralateral side of his maxilla.

It was explained to them that this was just the first step of his rehabilitation. He would need to return in four months for a zygoma implant following the consolidation of rib graft with the surrounding bone. The facial asymmetry that had resulted from the previous surgeries would be corrected by a series of surgeries.

Total Patient Satisfaction from Treatment at our Hospital

There was total patient satisfaction with all his family members expressing their happiness at the results of the surgery. They expressed understanding that they had to return in four months for the next surgery. The patient and his family thanked the staff before discharge from the hospital.

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Unilateral Cleft lip repair

Unilateral Cleft lip repair

Unilateral Cleft Lip Repair for Children with Cleft Lip Deformity

Cleft lip deformity can occur with varying severity. It can range from very mild to very severe. Most severe is the bilateral cleft lip and palate deformity. There is also a hole in the roof of the mouth in the upper jaw. The mildest form is the unilateral incomplete cleft lip deformity.

Ear infections are common in these children. The infection is transmitted through the Eustachian canal. These infections are controlled once the surgical repair is performed. Hearing problems subside following surgery.

The mildest form of cleft lip deformity is unilateral cleft lip deformity. It involves only one side of the lip and does not involve the alveolus or the palate. Unilateral cleft lip repair is the only surgical repair required for these children. The upper lip and nose is affected in cleft lip deformity.

Ramifications of Bilateral Cleft Lip Deformity on Quality of Life

The most severe manifestation of the deformity is the bilateral cleft lip and palate deformity with a free-floating premaxillary segment. A bilateral cleft lip deformity not only affects the esthetics but also the functional aspects of eating and speech. Rehabilitation for patients is usually lengthy and involves undergoing multiple surgical procedures.

First Attempts at Cleft Lip Surgery in Antiquity

Children born with cleft lip deformity often faced a very difficult life during ancient times. The Chinese were the first to attempt a rudimentary cleft lip surgery. Results from the surgery were varied with some very good results at times. History records a member of a royal family with a cleft lip deformity who had undergone successful surgical correction.

Reaction to Cleft Lip Deformity in the Ancient Past

Scientific temper developed only over the last 500-600 years around the world. The Renaissance played a very important role in developing the correct mindset towards life. Children born with a cleft lip deformity were viewed with suspicion in the ancient past. People associated them with the occult and rejected them.

Role of India in the Development of Facial Plastic Surgery

Susruta who is considered to be the father of facial plastic surgery lived in ancient India. Cutting off of the nose was a common punishment meted out to criminals. He was the first to advocate the use of forehead flaps for the reconstruction of nasal deformities arising from such punishments.

Rehabilitation of Cleft Lip Deformity through Modern Surgery

It was only after the advent of the modern age that cleft lip deformity correction was performed with finesse. Postsurgical scarring is also minimal with good esthetic and functional rehabilitation. Experienced surgeons offer very good results with complete patient satisfaction. Plastic surgeons also perform this surgery.

Lengthy Rehabilitation following Cleft Lip Surgery

When the cleft lip and palate deformity is severe, it often involves a lengthy rehabilitation. It involves undergoing a series of surgery to attain normalcy. The first is cleft lip surgery, which is performed at 3-1/2 months of age. This is followed by cleft palate surgery at 10 months of age.

The third surgery is the closure of the cleft alveolus at 4-1/2 years old through the use of bone grafts. This is followed in later years with maxillary advancement, scar revision and other such surgeries as needed. Speech therapy is also an integral part of the rehabilitation of cleft lip patients.

Experienced surgeons offer the best results for cleft lip surgery. The alar base also needs to be reconstructed. They are adept at molding the delicate soft tissue structures of the cleft lip and palate. It is not only a surgical science but also an art that involves an artistic eye for symmetry and proportions.

Center for Excellence in Facial Plastic Surgery and Cleft Lip Surgery

Our hospital is a renowned center for cleft lip surgery for over three decades now. We have been offering our services to patients from around the world. Many patients from Western nations including USA, UK, Germany and France come to us for facial plastic surgery.

We are the only Indian affiliate of the International Cleft Lip and Palate Foundation (ICPF) of Japan.  Our hospital is also the only Asian affiliate of the Dallas-based World Craniofacial Foundation (WorldCF) of the USA.

Baby Girl born with Unilateral Cleft Lip and Palate Deformity

This infant is from Shimla in Himachal Pradesh, India. She was born with a wide unilateral cleft lip and palate deformity. Her parents requested that they wanted the best treatment for their baby. They were then referred to our hospital for cleft lip surgery.

Initial Consultation and Treatment Planning in our Hospital

The treatment planning was explained to the parents in detail. They were given the “Advanced Treatment for Cleft Lip and Palate.” This is a concise handbook for parents authored by Dr. SM Balaji. Her parents expressed understanding of the same and consented to surgery

Successful Surgical Correction of her Cleft Lip Deformity

Surgery is performed under general anesthesia. She underwent cleft lip surgery at the age of 3-1/2 months. The floor of her nose and nasal sill were rebuilt with a C-flap. A meticulous approximation of the cleft lip was then performed in a three-layer closure. The structures of the lip to include the orbicularis oris, subcutaneous tissue and skin were perfectly aligned using a surgical loupe.

There were very good function and esthetic results from this surgical technique. Her parents were instructed to return when she was 10 months old for cleft palate repair. They expressed understanding of the instructions and thanked the hospital staff before discharge.

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