Jaw Joint Surgery and Scar Revision for Facial Asymmetry Correction
A 7-year-old girl from Hubbali, Karnataka, India had grade III hemifacial microsomia and macrostomia when she was born, which made it hard for her left lower jaw to grow. Important parts like the ramus, condyle, and temporomandibular joint (TMJ) didn’t grow properly because of the condition.
The Result: An uneven face and problems with function
This disease made the face look uneven and made it hard to eat and talk. The way she looked made her feel bad about her self-esteem. Several surgeries, including ones to fix macrostomia, were done to fix these problems.
Problems that cause depression
The surgery to fix her macrostomia worked, but it left a big scar on the left side of her face near the mouth commissure. This physical memory made me feel sad and brought down my self-esteem.
How to Understand Keloid Scars and TMJ Disorders
Keloid scars are known for getting bigger over time, which means they need to be removed using certain methods. It’s important to remember that TMJ disorders can have a big effect on face symmetry, which is a very noticeable part of how someone looks. Scars of different kinds can show up on the face.
Techniques for Removing Scars on the Face
In facial scar revision surgery, plastic surgeons use modern techniques, such as tissue expansion of the surrounding skin, to get great long-term effects.
The Choice: Surgery on the jaw joint and correction of facial imbalance
In order to deal with these problems, the patient’s parents set out to find the best medical centre for fixing the patient’s uneven face and fixing the scars. For the repair of the TMJ, surgery on the jaw joint was also needed.
The Choice: A Top Centre for Fixing Facial Asymmetry
The family found our hospital, which is a well-known centre for facial plastic surgery, after doing a lot of study and talking to doctors and nurses. We are experts at treating face burns, getting rid of facial scars, and performing specialised jaw reconstruction surgery.
Rib bone grafts are the gold standard.
Rib bone grafts are used at our hospital because they are thought to be the best type of bone graft. With this method, you don’t have to worry about the ugly scars that come with grafts taken from long bones.
A centre for craniofacial surgery that has won awards
We are happy to be the regional branch of the World Craniofacial Foundation (WorldCF), which is based in the United States and is a superspecialty centre for craniofacial surgery. People from all over the world come to our centre to get better.
Cutting-edge skills and technology
To get the best results, we use both cutting-edge technology and the newest surgery methods. Sonic welds cut down on the number of second surgeries that need to be done. Our cutting-edge operating rooms are equipped with the newest technologies.
How to Get Through the COVID Pandemic
During the COVID-19 pandemic, which caused a global health disaster, our hospital quickly changed to follow WHO and CDC guidelines. Getting the COVID safe approval was a big step towards making people more aware.
How to Succeed: Surgery to Remove the Scars from Macrostomia
A bone and a costal rib graft, complete with an entire perichondrium, were used in a very well planned treatment. The perichondrium was very important in rebuilding the jaw joint that wasn’t there.
Surgery on the jaw joint went well, and the scars were healed.
The costal rib graft was used to successfully repair the patient’s jaw joint, resulting in a functional TMJ. The bone graft was also used to rebuild the left lower jaw that wasn’t growing properly. Carefully done scar correction surgery made sure that few scars would form.
Fixing the Asymmetry of the Face
After the surgery, there were big changes in the unevenness of the face. Surgery on the jaw joint fixed the problem so that the lower jaw could move properly again, and surgery to fix scars made the face look better.
A Better Tomorrow
This all-around method rebuilt the anatomy of a left temporomandibular joint. Bone grafts helped restore face balance, which will allow the patient’s jaw to grow normally as they continue to grow.
In conclusion, surgery on the jaw joint and revision of scars have not only fixed uneven face features but also made it possible for better function and appearance. Getting the right care and treatment is the first step towards a better future.
Nasal deformities are prevalent, often encompassing a range of issues, including flat and broad nose deformities. When it comes to addressing these concerns, plastic surgery of the nose, or nose correction surgery, is the primary solution.
Utilizing Cartilaginous Grafts for Nose Bridge Augmentation
For individuals with flat nose deformities, nose bridge augmentation offers an effective remedy. This involves using costal cartilaginous grafts to enhance the nose bridge, resulting in a remarkable improvement in overall facial aesthetics.
Plastic Surgery of the Nose for Enhanced Form and Function
Rhinoplasty, a plastic surgery procedure focusing on nasal modification, can significantly impact both form and function. It’s important to entrust this technique-sensitive surgery to an experienced surgeon. Patients who undergo plastic surgery for their noses often experience a boost in self-esteem due to improved aesthetics.
The Documented History of Rhinoplasty Since Antiquity
The roots of rhinoplasty extend back to ancient times, with India’s own Sushruta earning recognition as the pioneer of plastic surgery. Thousands of years ago, he successfully performed plastic surgery on the nose, a testament to the enduring nature of this practice.
Evolution of Modern Rhinoplasty for the Modern Age
Modern rhinoplasty has evolved to meet the growing demand for nose correction surgery. This not only enhances facial aesthetics but can also improve breathing function, refining the definition of one’s facial features.
A Shift from Exclusive to Inclusive: Plastic Surgery for All Generations
In the past, rhinoplasty was primarily reserved for the rich and famous due to its prohibitive cost. However, recent economic liberalization has changed the landscape. With increased disposable income, more people are conscious of their facial appearance, leading to a surge in cosmetic procedures. Rhinoplasty has become one of the most sought-after procedures among younger professionals.
Specialized Plastic Surgery by Oral and Maxillofacial Surgeons
Oral and maxillofacial surgeons, experts in facial surgery, including cosmetic procedures, possess in-depth knowledge of facial musculature and bone structure. They play a vital role in correcting nasal deformities, which can result from various conditions, including syndromic abnormalities like cleft lip and palate deformities.
Rhinoplasty Unveiled: Types and Common Reasons
Rhinoplasty, often referred to as a “nose job,” comes in different forms, including open and closed rhinoplasty. Deviated nasal septums, a common issue, necessitate nose surgery, involving modifications to nasal bone and cartilage. Patients are advised against blowing their noses for several weeks following the procedure, which is typically performed under general anesthesia.
Leading the Way in Facial Deformity Correction
Our hospital specializes in the correction of facial deformities and is renowned worldwide for its expertise in treating nasal deformities. For over 30 years, we have provided comprehensive surgical care for various facial deformities, including ear reconstruction for microtia patients, jaw correction surgery, total facial makeovers, and facial feminization surgery.
Internationally Acclaimed Excellence in Surgical Care
Our hospital has earned international recognition for its commitment to correcting cleft-related facial deformities. Patients from around the world travel to India to avail our services, with the Word Craniofacial Foundation (WorldCF) and the International Cleft Lip and Palate Foundation (ICPF) acknowledging our contributions.
Transforming Lives: A Rare Case of Binder’s Syndrome
One compelling example is a young girl born with Binder’s syndrome, a rare congenital disorder affecting the nose and jaw structures. After initially seeking treatment at a local hospital, she was referred to our institution. The treatment plan, including the use of costal cartilaginous grafts, was thoroughly explained and received the patient’s consent.
Harvesting and Crafting for Nasal Reconstruction
The procedure involved harvesting costal cartilage grafts from the patient, maintaining thoracic cavity patency. These grafts were skillfully shaped and crafted to achieve the desired dimensions.
Enhanced Nasal Form and Function Post-Rhinoplasty
The results were nothing short of remarkable – the patient experienced a dramatic improvement in her appearance and significant enhancement in her breathing after the augmentation rhinoplasty.
Because of a failed surgery in the past, this young man came to our hospital with ptosis, sunken eyes, and serious orbital dystopia. We fixed the problems by taking out the extra tumour, changing the supraorbital area, and moving the medial canthal ligament using the scar that was already there.
We raised the floor of the orbit by making a cut under the ciliary, and an Endotine device raised his left eyebrow. He thanks Dr. SM Balaji for giving him his life back with tears in his eyes because of how much he had changed.
Discover the story of a young man who had a tough trip from being told he had a supraorbital tumour to having surgery in India to fix his eyes. Unfortunately, his first surgery caused problems that were not expected, such as ptosis, sunken eye deformity, and serious orbital dystopia.
We’ll learn about how Dr. SM Balaji and his team saved this young man’s life through cutting-edge surgery in this amazing story.
Orbital reconstruction surgery in India is a procedure that aims to restore the normal shape and function of the eye socket after an injury or a tumor removal. Here are some points to know about this surgery:
It involves repairing or replacing the bones, muscles, and ligaments
Fixing Mistakes Made in the Past:
It was in his city that the young man had surgery for a supraorbital tumour. Sadly, the process took bone from the wrong places, which caused a lot of problems with how the body looks and works. He came to our hospital for help because he was determined to get his quality of life back. A skilled team of doctors was ready to do a second surgery.
Using the scar that is already there:
One of the best things about the second surgery was that the first scar was used. This made it possible for the surgeons to get to the hurt area without having to make any more cuts. By reducing the number of new marks, the patient would look much better overall.
Precise methods of surgery:
First, the surgeons carefully reshaped the supraorbital area while removing the extra tumour. A Y-plate canthopexy surgery was done to fix the displacement of the medial canthal ligament. With this method, the ligament is moved around to get it back into the right place and working properly.
How to Fix Sunken Eye Deformity:
Fixing the abnormality of the sunken eyes was one of the hardest parts of the surgery. This was done by making a cut under the ciliary to raise the floor of the orbit. This new method made it possible to fix the patients’ sunken look all over, which made their facial symmetry much better.
Improving the Position of the Brows:
The journey of surgery didn’t end there. The levator muscle was hung from an Endotine implant to lift the patient’s left eyebrow and make the face look more balanced. This method supported the eyebrow for a long time and gave it a natural lift.
Return of Life:
In India, the young man had surgery to rebuild his orbit, which made his face look completely normal again. After Dr. SM Balaji gave him his life back, he was so thankful that he cried tears of joy. In the field of orbital reconstruction, this success story shows how advanced surgical methods can change things.
It has become possible for people in India to change their lives with orbital repair surgery, like the young man in this story. With the help of Dr. SM Balaji and his team’s skill, this patient was able to get over the problems caused by a previous surgery and improve his confidence and the way his face looks.
This case shows how important it is to get specialised care and how amazing it is that modern surgical methods can save lives.
Obstructive sleep apnea is the condition where breathing is interrupted during sleep. This is caused by insufficient space for the tongue in a retruded lower jaw. The tongue falls back into the throat during sleep and obstructs the airway. This results in a pause in breathing followed by a brief awakening with a popping sound.
The resultant hypoxemia causes frequent arousals throughout the night. These episodes of periodic wakefulness stimulate the sympathetic nervous system. This results in vasoconstriction and reduced peripheral blood flow. There is an associated increase in heart rate and blood pressure due to this.
This is an extremely disruptive condition that leads to snoring and interrupted sleep. The person feels sleep deprived even after a full eight hours of sleep. It is usually the person’s sleeping partner who first notices this condition. There is also excessive daytime somnolence due to the poor quality of sleep caused by sleep apnea.
Restless legs syndrome can also be a result of obstructive sleep apnea. Wearing oral appliances during sleep can help with obstructive sleep apnea. This helps maintain constant positive airway pressure. Risk factors for complications are minimal through these appliances can be cumbersome.
Sleep labs conduct studies to diagnose sleep disorders. There is often blockage of the upper airway in sleep disorders. Management of obstructive sleep apnea can both be done through medical and surgical means. Both are equally effective at correcting sleep-disordered breathing. These disorders can also cause loud snoring.
Prolonged sleep disorders can lead to high blood pressure and heart disease. This increases your risk for life-threatening events. Oxygen level drops drastically in obstructive sleep apnea. Tongue and soft palate fall back obstructing the throat and breathing. The patient needs to stay overnight during a sleep study.
Need to Undergo Sleep Study for Confirmation of Obstructive Sleep Apnea
A sleep study, which is known as polysomnography in medical parlance, is a test to diagnose sleep apnea. This is conducted in a sleep lab. The patient is hooked up to several monitors during sleep. These record the brain waves, level of blood oxygen, eye movements, heart rate, breathing and movement of extremities.
Patient Referred to our Hospital Following Sleep Study
The patient is a 21-year-old male from Secunderabad in Telangana, India. He stated that he has been plagued with disturbed sleep since he can remember. There were frequent episodes of interrupted sleep throughout the night. These episodes were accompanied by an audible popping sound.
He was also a heavy snorer. There was excessive daytime somnolence despite a full night’s sleep. He also complained of always feeling tired.
His parents had consulted a doctor in their hometown who had referred them for a sleep study. The results of the study came back indicative of obstructive sleep apnea. They were referred to our hospital for management since they requested the best surgical care.
Specialty Center for Jaw Correction Surgery
We have been performing jaw correction surgery for over 30 years now. Mandibular advancement with a bilateral sagittal split osteotomy (BSSO) is a specialty surgery performed at our center. Patients regularly undergo BSSO for asymmetry correction of the mandible. We use advanced digital facial biometric studies to ensure the best cosmetic and functional results.
Initial Consultation at our Hospital for Management of Sleep Apnea
Dr. SM Balaji, a Sleep Apnea specialist, examined the patient and ordered imaging studies. He analyzed the results of the sleep study in detail. The patient had a retruded mandible.
A treatment plan was formulated and presented to the patient and his parents. They were in full agreement with the treatment plan and consented to surgery.
Genial Tubercle Advancement and BSSO Advancement of Lower Jaw
Genial tubercles are bony protuberances that are situated on the lingual side of the anterior mandible. They are located bilaterally in the region of the lingual foramen. Two muscles are attached to the genial tubercle. These muscles play a very important role in the mechanism of sleep apnea.
They are the geniohyoid and genioglossus with the former pulling the hyoid bone forwards and upward. The genioglossus helps protrude the tongue and pull it to the opposite side.
In a retruded mandible, the pull from these muscles is not sufficient to keep the tongue from falling backward during sleep. Surgical forward positioning of the genial tubercle will help address this issue. The tongue also does not have sufficient space in a retruded mandible.
Successful Completion of BSSO and Genial Tubercle Advancement
The genial tubercle was advanced and stabilized anteriorly using plates and screws. This was followed by BSSO with the advancement of the mandible by 12 mm. The inferior alveolar nerve was mobilized with the proximal segment. Care was taken to ensure that there was no injury to the nerve throughout the surgery.
A Le Fort I maxillary osteotomy was next performed to ensure correction occlusion with the mandible. Occlusion was checked before stabilization with plates and screws. This also resulted in a dramatic improvement of the patient’s facial esthetics.
Resolution of Sleep Apnea with Normal Postsurgical Sleep Study
The patient subsequently underwent a sleep study in his hometown. All parameters were normal in this sleep study.
His obstructive sleep apnea symptoms had completely resolved. He had also stopped snoring during sleep. Oxygen saturation levels were normal.
His parents reported that he slept fitfully throughout the night. The patient also reported that he felt refreshed upon waking up. Daytime somnolence had also completely resolved.
Complete Patient Satisfaction with Treatment at our Hospital
The patient and his parents were delighted with the results of the surgery. His parents stated that he seemed like a new person with a lot of energy and focus. He too stated that there was a greatly improved overall quality of life.
They expressed their gratitude to the hospital staff for the care and attention rendered during their hospital stay.
Patient born with bilateral cleft lip and palate deformity
The patient is a 7-1/2-year-old girl from Sadurangapattinam in Tamil Nadu, India. She was born with a bilateral cleft lip and palate defect. It was very severe. Her parents were extremely distressed upon seeing the degree of her facial deformity. They were reassured at the hospital that this could be surgically managed.
The incidence of cleft deformities among newborns is higher in the Sadras region than the national average. Many infants born with this deformity have been successfully rehabilitated in our hospital. Some of the patients who were operated on over 20 years ago are now happily married with children of their own.
The patient and her parents were referred to our hospital for surgical management of her cleft defects. It was explained to them that the road to total cleft rehabilitation was a long one. They stated a complete understanding of this. Plastic surgeons also perform this procedure in western countries.
She first underwent bilateral cleft lip repair at the age of 3 months. This was followed by cleft palate repair at 11 months of age. The premaxillary setback with bone grafts to the region of the cleft alveolus was also performed for the patient.
Continuation of the rehabilitation process at our hospital for the patient
Orthodontic consultation was also initiated for the patient. Our hospital is a super-specialty center for cleft orthodontics in India. She will need extensive orthodontic intervention in later years.
Her teeth are malaligned due to her cleft deformity. She also has a few congenitally missing teeth. The remaining teeth will need to be brought into perfect alignment. Dental implant surgery would ensure the replacement of her missing teeth. This final step would complete her rehabilitation. Soft tissue molding would also be perfect following this step.
She still had nasal deformities that needed to be corrected. There was a collapsed columella. This caused extreme flattening of her nose. She also had a very blunt nasal tip. Some patients also have asymmetry of the alar bases.
There was also stunting of the prolabium with a resultant short upper lip. The patient was instructed to present for correction of these deformities.
Surgical planning for correction of her collapsed columella and stunted prolabium
Dr. SM Balaji, cleft nose correction surgeon, examined the patient and obtained pertinent studies. The patient would require an open rhinoplasty with the reconstruction of philtrum. It was decided to reconstruct her collapsed columella with a flap dissected from the prolabium. The resultant prolabium defect would be reconstructed using a lower lip Abbe flap.
It was explained to the patient that she would not be able to open her mouth for two weeks following surgery. This period would enable revascularization of the Abbe flap from the upper lip tissue. They were in agreement with the treatment plan and consented to surgery.
Cosmetic and functional rehabilitation of her cleft related deformities
Under general anesthesia, markings were made on the prolabium. This was followed by a dissection of the prolabium and the columella. The lower lateral cartilages were identified, dissected and separated.
Medial crura were sutured together as well as to the nasal septum. This would ensure a sharp alar dome. Prolabium was then utilized to reconstruct and lengthen the columella.
A full-thickness Abbe flap was then raised from the lower lip to reconstruct the prolabium. Extreme care was taken to ensure patency of the inferior labial artery in the flap tissue. The flap was then sutured to the region of the upper lip defect.
Blood supply would be from the inferior labial artery until the establishment of supply from the upper lip. The inferior labial artery is a branch of the facial artery. This arises near the angle of the mouth, at the region of the edge of the lower lip
Separation of the lower lip flap from the upper lip with good flap vascularity
Abbe flap was separated after a period of two weeks. There was good perfusion of blood within the upper lip flap. She now had a sharp nose with a long columella. Her nose now had a straight profile.
The upper lip also had adequate length due to the lengthened prolabium. This provided increased lip tissue for her to appose her lips together. Visible scar tissue was also negligible following the surgery. She expressed her satisfaction with the cosmetic results from the surgery. Her parents too were very happy with the results of the surgery.
Patient with a Hereditary Tendency for a Large Lower Jaw Running Through his Family
The patient is a 24-year-old male from Ludhiana in Punjab, India. He has always had a large lower jaw. This caused an unattractive facial structure. The scientific term for this is mandibular prognathism. Many members of his family also have a large lower jaw.
Functional and Esthetic Difficulties Caused by Mandibular Prognathism
This has caused him to have problems with eating and speech. He has also felt very self-conscious because of the cosmetic compromise from the large jaw. Desiring to get this corrected, he and his parents made inquiries with many surgeons including dentists and oral surgeons. They had been referred to our hospital for surgical correction.
Certain syndromes have been associated with a large lower jaw. Acromegaly, which is a condition caused by excess growth hormone in adults results in mandibular prognathism. A percentage of these patients also have gum disease due to chronic mouth breathing.
Specialty Procedures performed in our hospital
A common term for a very large lower jaw is lantern jaw. The chin is extremely prominent and forwardly positioned. Mastication and speech are rendered very difficult in these cases. Patients undergoing facial feminization also undergo jaw reduction procedures.
Jaw reduction surgery is routinely performed in our hospital. All these surgeries are performed under general anesthesia in our state of art operating theatres.
Initial Consultation and Examination at our Hospital
Dr. SM Balaji, Specialist in Jaw Surgery, examined the patient. A detailed history was also obtained. He then ordered imaging studies including a 3D CT scan. These are mandatory for patients undergoing jaw surgery.
This showed that the patient had a skeletal overbite of 12 mm. There was also a horizontally impacted right third molar. He had bilateral impacted wisdom teeth. These were also indicated for removal.
Treatment Planning Explained in Detail to Patient and his Parents
Treatment planning was modified as the patient wanted to undergo both procedures at the same time. The mandibular setback is usually performed six months after wisdom tooth extraction, but an exception was allowed in this patient.
The patient will first undergo presurgical fixed orthodontics to decompensate the arch. This would be followed by surgery and postsurgical orthodontics. The last stage of orthodontics would be fine-tuning his dental occlusion. They then consented to surgery.
Wisdom Tooth Surgery Followed by Mandibular Setback
Under general anesthesia, both impacted third molars were extracted. Sectioning of the left third molar was performed to enable easy wisdom tooth extraction. Attention was turned to the bilateral sagittal split osteotomy (BSSO) following wisdom teeth extraction. The bilateral sagittal split osteotomy would enable backward positioning of the lower jaw to achieve good alignment with the upper jaw.
Preservation of Inferior Alveolar Nerve throughout Surgery
Bilateral sagittal split osteotomies were made. The inferior alveolar nerve was mobilized with the proximal segment. This allowed for mobilization of the distal segment. A slice of bone 14 mm was removed from the site of the osteotomy.
The mandible was then set back and occlusion was checked. Stabilization of the mandibular segments was performed with plates and screws. Care was taken to ensure that the inferior alveolar nerve remained safe throughout the procedure.
Complete Patient Satisfaction with Results of Surgery
There was a tremendous immediate improvement in facial esthetics. The patient and his family were very happy with the results of the surgery. They expressed their satisfaction before their final discharge from the hospital.