Lower Incisor Over Show Recorrection Genioplasty

Lower Incisor Over Show Recorrection Genioplasty

A patient opts for surgical creation of a more prominent chin

The patient is a 45-year-old male from Bhopal in Madhya Pradesh, India. Ever since he was a young man, he had always felt that he had a very small chin. He had always been dissatisfied with the shape of his chin. His desire was to have a prominent chin, which he felt would be more masculine looking.

Around a year ago, he finally decided to undergo chin enhancement surgery. He, therefore, got in touch with a facial cosmetic surgeon. Without any presurgical planning, the surgery had been performed on the very same day.

Dissatisfaction with the results of the surgery

A genioplasty had been performed with osteotomy of the chin. To his dismay, the patient realized that he could not close his lips fully. There was an unsightly excessive lower incisor overshow. He could not appose his lips.

Feeling distressed by this, he realized that his surgery needed to be redone. He began an exhaustive search for the best surgical facility to address his issue. His search repeatedly led him to our hospital.

Our hospital is a specialty surgical center for cosmetic resurgery. Many patients with botched cosmetic surgery elsewhere have undergone surgery with us with the optimal restoration of esthetics. Cosmetic lip surgery and redo rhinoplasty (revision rhinoplasty or nose job) are specialty procedures performed at our hospital.

Facelift surgery is routinely performed in our hospital. Facial plastic surgery procedures have helped many people lead fulfilling lives. Facial implants are used for correcting bony defects by plastic surgeons. Chin implant surgery is performed for enhancing retruded chins. This results in optimal chin augmentation.

Our hospital follows all the protocols laid down by the American Society of Plastic Surgeons. Head and neck surgery had rigorous guidelines that need to be followed for optimal results.

Treatment planning explained to the patient in detail

Dr SM Balaji, facial cosmetic surgery specialist, examined the patient and obtained imaging studies including a 3D CT scan. This revealed an enormous gap between the osteotomized chin and the mandible. It was explained to the patient that this gap needed to be closed as there was no new bone formation.

Care was taken to explain to him that the best course of treatment would be to reverse the previous surgery. The patient contemplated the findings presented to him and consented to surgery.

Successful reversal of his previous advancement genioplasty surgery

Under general anesthesia, a vestibular incision was made in the anterior mandibular region. The previous chin surgery with the titanium plates was exposed. There was extensive granulation tissue formation at the site of the bony gap in the chin.

The granulation tissue was carefully debrided. The titanium plates and screws holding the chin were removed and the chin was placed back into its original position. There was a good approximation of the osteotomized segment with the mandible. The incision was then closed and the patient was taken to the recovery room.

Patient happy with regaining previous facial dimensions after reversal of chin surgery

The patient’s chin had been placed back in its original position. Overshow of lower incisors was completely eliminated. He was extremely happy with the results of the surgery and thanked the surgical team before being discharged from the hospital.

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Dental Implant after Jaw Resection and Reconstruction

Dental Implant after Jaw Resection and Reconstruction

Common Jaw Pathologies that require Resection and Reconstruction

Cysts and tumors of the jaws are amongst the most common jaw pathologies. Treatment of these conditions includes jaw resection and reconstruction. The most common cysts of the jaws include dentigerous cysts and odontogenic keratocysts. Dentigerous cysts are always associated with an impacted tooth.

Importance of Jaws towards Overall Human Health

The importance of the jaws towards maintaining optimal physical and mental health cannot be understated. Proper mastication of food is very important in obtaining the nutrition that the body needs to maintain good health. Jaws also play an important role facilitating overall human health.

Effects of Jaw Pathology on Speech and Facial Esthetics

The effects of jaw pathology on speech and facial esthetics can result in a compromise in the overall quality of life. Speech therapy is often required after radical resection of jaws and jaw reconstruction surgery. Maxillofacial surgeons receive specialized training for jaw cyst surgery.

Importance of Jaw Reconstruction Surgery for Returning to Normal Life

Patients who have undergone resection of extensive jaw pathologies are often left with residual facial deformities. Patients thus affected require jaw reconstruction surgery for returning to normal life.

Cystic conditions like dentigerous cysts and odontogenic keratocysts often cause the destruction of the jawbone. Mastery over jaw reconstruction surgery takes many years to attain and is technique sensitive.

Preferred Sites for Harvesting Bone Grafts for Jaw Reconstruction Surgery

Bone grafts for jaw reconstruction surgery are harvested from three preferred sites. The preferred sites for harvesting bone grafts among different surgeons include the long bones of the legs, hips and ribs.

Harvesting sufficient bone from the hips leads to a deformity in the region. An unsightly scar is usually the result of harvesting sufficient quantities of bone from the tibia.

Ideal Site for Harvesting Bone for Jaw Reconstruction Surgery

The ideal site for harvesting bone for jaw reconstruction surgery is from the rib region. There is complete regeneration of the bone when the periosteal continuity is not compromised following surgery. Scarring is also minimal as multiple grafts can be harvested through a single incision.

Leading Center for Jaw Reconstruction Surgery and Facial Plastic Surgery

Our hospital is a leading center for jaw reconstruction surgery following resection of jaw pathologies. Results from facial plastic surgery have won us many international accolades. We have over 30 years of experience in successfully reconstructing a wide variety of jaw defects.

Types of jaw surgery performed here include orthognathic surgery and surgery for receded lower jaws. Other procedures performed include removal of odontogenic cysts and mandibular osteotomy. Corrective jaw surgery is performed through intraoral small incisions.

We also address radicular cysts, nevoid basal cell carcinoma syndrome, giant cell lesions and fibrous dysplasia.

Patient Referred to our Hospital for Management of the Jaw Pathology

The patient is an 18-year-old female from Cuttack in Odisha, India. She had developed pain and swelling in the right side of her mandible approximately one year ago. The swelling was gradually progressive and greatly alarmed them.

They presented at a local hospital where imaging studies demonstrated a radiolucent lesion enclosing an impacted third molar. The lesion extended from the body into the ramus of the mandible. A diagnosis of dentigerous cyst was made.

She had subsequently undergone enucleation of the cyst. The teeth associated with the cyst were also extracted. Jaw reconstruction had however not been performed. The patient and her parents were very unsatisfied with the treatment.

Unfortunately, the swelling and pain returned approximately four months ago. They had visited another local hospital where imaging studies had been obtained. Diagnosed with a recurrent dentigerous cyst, they were referred to our hospital for management of her recurrent dentigerous cyst.

Initial Presentation at our Hospital for Redo Dentigerous Cyst Surgery

The patient and her parents made their initial presentation at our hospital for her redo dentigerous cyst surgery. Our hospital exclusively uses bone grafts harvested from the ribs. We have successfully performed redo dentigerous cyst surgery for many patients with failed iliac and femoral grafts.

Jaw Reconstruction Surgery followed by Dental Implant Surgery

Treatment planning was explained to the patient and her parents. They consented to the redo dentigerous cyst surgery. She first underwent the redo dentigerous cyst surgery. This was followed by jaw reconstruction surgery using titanium reconstruction plate and rib grafts.

A second procedure was performed four months later. This was dental implant surgery in the reconstructed jaw bone. The time period was to allow for consolidation of the bone grafts with surrounding alveolar bone. The patient and her parents were very happy with the results of the surgery.

Patient Instructed to Return in Four Months for Ceramic Crowns

The patient and her parents were instructed to return in four months for ceramic crowns. This interim period would allow for complete osseointegration of the dental implants to the surrounding bone.

The patient and her patents expressed understanding of the instructions. They were very happy with the level of care given to them at our hospital.

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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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