Facial Reconstruction Surgery

Tumor

A tumour is an abnormal mass of tissue resulting from uncontrolled and uncoordinated growth of normal cells. Jaw tumours that arise from tooth forming tissues are called odontogenic tumors. The jaw tumours that arise from tissues other than tooth forming tissues are referred to as non odontogenic and they may occur in regions other than the jaw bone. Tumours are classified as malignant or benign according to their biologic nature.

Facio-Maxillary Surgeon Dr. S.M. Balaji is highly proficient at jaw tumor removal and complete facial reconstruction. He has successfully rehabilitated innumerable patients afflicted with jaw tumor. He has introduced several surgical innovations which have immensely benefitted the patients, including biotechnologically advanced protein rhBMP-2 which stimulates new bone formation when placed in bone deficient regions and Transport Distraction Osteogenesis which stretches and expands bone and overlying soft tissues. These are some techniques used here routinely for complete facial reconstructive surgeries.

Dr. S.M. Balaji is a skilled specialist in facial reconstructive surgeries. He has successfully employed several advanced procedures, often a combination of more than one technique, to completely reconstruct the face of several persons with facial disfigurements. He is internationally acclaimed for his prowess in reconstructing facial features providing a wide range of treatment options for both children and adults with severe facial defects.

Jaw tumour resected and total jaw reconstructed for a one year old child for the first time

Child at 7 months of age with no evidence of disease

Child at 7 months of age with no evidence of disease

Child at 18 months of age with tumour in upper and lower jaw

Child at 18 months of age with tumour in upper and lower jaw

For the first time in the world, a rare type of facial and jaw bone disorder was rehabilitated completely for a one year Maldivian Child. The child was suffering from a rare form of osteodystrophy. In the disorder, the bones are gradually replaced by the fibrous tissues. This disorderly bone formation would result in the complete destruction of the involved bone. When jaw and facial bones are affected as in the case of this one year old boy, it leads to disfigurement in addition to speech difficulties, feeding problems and most importantly the psychological development.

Rare Facial Disorder

The treatment option for osteodytrophy is surgery that is usually done when most of the growth of child ceases, that is by 15 years. For this child, beside the other problems, he will have impeded facial growth, if not correctly treated. The boy suffered this disorder in the upper and lower jaw. Distorted jaws will impede the growth of the other facial bones too. Entire upper jaw and almost the entire lower jaw except the joint were involved with disease. Hence an urgent facial surgery was the only option with a careful post-operative monitoring. Many centers across the globe and India, did not readily take up the child owing to issues with age, disease severity and multiple problems with reconstruction. Rehabilitation is tough as the patient is a young child where microvascular surgery is tough owing to smaller size of the blood vessels. Use of revolutionary cutting edge technology – bone morphogenetic protein-2 (rhBMP-2) was employed for this child. This involves recruiting the stem cells to synthesize required new bone.

Balaji Dental and Craniofacial Hospital, Chennai

Parents were referred to Balaji Dental and Craniofacial Hospital, Chennai for expert advice and management. The renowned and internationally acclaimed craniofacial surgeon, Dr. S.M. Balaji readily took up the challenge to help out the child and his parents in distress. After advanced investigations and meticulous planning, the surgery was executed. The surgical team under Prof. Dr. S.M. Balaji performed this exceptional surgery for the first time,that extended beyond 6 hours. The titanium plate used for the surgery was customized by Dr. S.M. Balaji himself and was procured from the U.S. The bone for reconstruction was harvested from a rib of the child that would eventually grow back to its normal size.

CT scan image showing tumour in upper and lower jaw

CT scan image showing tumour in upper and lower jaw

Surgery

The highlight of this surgery was that the entire surgery was performed through the mouth itself. This eliminated the incidence of scars on the child’s face. This was for the first time a 1 year old child from a foreign country was operated for such a disorder in India. The lengthy surgery involved removal of the diseased portion of the jaw, reconstruction with a customized, imported, titanium plate and the child’s own rib graft. To promote and balance bone union, bone morphogenetic protein-2 (BMP) was employed. This protein would attract the pluripotential cells to synthesize the bone. The child responded well to the treatment and returned to his homeland with happy and contented parents.

Removal of the tumour from the upper jaw

Removal of the tumour from the upper jaw

Removal of the tumour from the lower jaw

Removal of the tumour from the lower jaw

Jaw reconstruction using bone graft and rhBMP-2

Jaw reconstruction using bone graft and rhBMP-2

Follow-up

Postoperative CT scan image

Postoperative CT scan image

The child a few months after jaw tumor removal

The child a few months after jaw tumor removal

After six months, a follow up CT scan was done. The CT scan revealed a good amount of normal bone formation in the jaws. Entire lower jaw has grown uniformly and active bone formation is proceeding to the expected level. In the event of not using BMP, the graft would have been resorbed. If the plate is only used, no bone would have been formed.

Dental rehabilitation with Implants

Since tumor affected portions of the jaws were removed, the boy will not have his natural teeth in those regions of the jaws. To facilitate normal chewing, eating and speech development and for overall good health of the boy, dental implants were placed in his jaw bones. After osseointegration of the implants with the surrounding new jaw bone, ceramic (porcelain) crowns resembling natural teeth will be fixed onto the implants.

The child with Dr. S.M. Balaji before dental implant surgery

The child with Dr. S.M. Balaji before dental implant surgery

X-ray before implant surgery, showing good healing and recovery

X-ray before implant surgery, showing good healing and recovery

Lower jaw before placement of implants

Lower jaw before placement of implants

Implants being placed in the lower jaw

Implants being placed in the lower jaw

Implants being placed in the lower jaw

Implants being placed in the lower jaw

Implants placed in the upper jaw

Implants placed in the upper jaw

The child a few months after jaw tumor removal

X-ray after dental implant placement

The child with Dr. S.M. Balaji after dental implant surgery

The child with Dr. S.M. Balaji after dental implant surgery