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Surgery

Facial Paralysis Surgery – Static Suspension

Facial Paralysis Surgery – Static Suspension

Facial Paralysis Surgery in India

What is Facial Paralysis?

Bell’s palsy can be caused by a viral infection. It almost never happens more than once.
Bell’s palsy is described by muscle weakness, which causes one-half of the face to droop.
Bell’s palsy normally goes away on its own after six months. Physiotherapy can help prevent muscles from contracting indefinitely.

Patient with Facial Paralysis seeks Solution for his Problem

The patient is a 27-year-old male from Rourkela in Odisha, India. He has had long-standing facial paralysis on the right side of his face. There was a drooping of the corner of the mouth on the affected side. He had tried a variety of medical treatments, which failed to address his problem.

Referral to our Hospital for Treatment of his Condition

This had left him feeling very frustrated. Seeking a solution, he had visited a cosmetic surgeon in his hometown. He underwent a dynamic reanimation with temporalis reanimation surgery. There was no improvement in his facial paralysis and this surgery was a complete failure.

An internet search for the best facial paralysis surgery hospital in India had brought up our name. Having satisfied himself with the search results, he contacted our hospital manager and fixed an appointment for an initial consultation.

Specialty Center for Facial Cosmetic Surgery in India

We are a leading center for facial paralysis surgery in India. Our hospital is well known for facial plastic surgery in India. We are a specialty center for the correction of drooping mouth. This most commonly is caused by facial paralysis.

We offer advanced treatments with the latest innovations from around the world. The cost of lip paralysis surgery in India is a fraction of what it costs in the West. Board-certified plastic surgeons often perform these surgeries in Europe and Japan.

Regaining Movement in Paralyzed Face

Facial reanimation surgery is also performed in our hospital. Patients come from around the world for this surgery. The patient regains the ability to emote following this surgery.

Surgery for Correction of Facial Deformities

Many conditions lead to facial asymmetry. The asymmetry can either be isolated to the soft tissue like in facial paralysis. It can also be due to underlying bony deformities. Facial palsy is caused by loss of innervation to facial muscles on one side supplied by the facial nerve.

Viral infections are a frequent cause of facial palsy (Bell’s palsy), but a majority of such cases recover spontaneously. We also specialize in facial asymmetry surgery. Scores of patients have been rehabilitated after undergoing surgery in our hospital.

Initial Consultation at our Hospital

Dr. SM Balaji, facial cosmetic surgeon, examined the patient. He obtained a detailed history and spoke with the patient at length. Treatment planning was discussed with the patient. The mechanism of static suspension surgery was explained to him.

He was encouraged to ask questions and clear his doubts. Once all his questions were answered to his fullest satisfaction, he expressed understanding and consented to undergo surgery.

Successful Cosmetic Rehabilitation of Facial Paralysis

Surgery commenced with harvesting a fascia lata graft from the thigh. The incision was closed with sutures once the graft was harvested. Attention was next turned to the face. An elliptical incision was made over the nasolabial fold. Orbicularis oris muscle fibers were then identified.

The fascia graft was tunneled up to the zygomatic arch. The graft was then looped around the arch to form a circumzygomatic sling. Care was taken to ensure that there was no damage to any nerves or vessels.

Both ends of the fascia lata sling were then sutured to the orbicularis oris. There was a good improvement of facial symmetry following this procedure.  A lateral tarsorrhaphy was also performed as his cornea was getting ulcerated due to his inability to oppose the left eye.

Total Patient Satisfaction with Results of Surgery

The patient was very happy with the results of the surgery. He expressed his gratitude to the surgical team before discharge from the hospital.

Surgery Video

Facial Asymmetry Correction by BSSO Surgery

Facial Asymmetry Correction by BSSO Surgery

Facial Asymmetry Surgery by bilateral sagittal split osteotomy (BSSO)

Patient with a Progressive Increase in Lower Jaw Size

The patient is a 21-year-old male from Durgapur in West Bengal, India. He has always had a very large lower jaw in comparison to his upper jaw. There was also a slight deviation of the lower jaw to the right. This resulted in a mild asymmetry of his lower face.

A bilateral sagittal split osteotomy (BSSO) is the surgery of choice for reducing a large lower jaw. A receded lower jaw is advanced using distraction osteogenesis. Internal distraction is safer and preferred over external distraction. The open bite caused by upper jaw abnormalities is corrected through maxillary osteotomy.

Size discrepancy between the jaws can lead to a lot of functional difficulties. Speech is altered and eating patterns are also altered. Left unaddressed, this could possibly also lead to problems with the temporomandibular joint (TMJ). Cosmetic compromise is another important aspect that could lead to issues with self-esteem and self-confidence.

Associated Difficulties Caused by his Jaw Asymmetry

He has also faced speech and eating difficulties throughout his life. Of note, his brother also has a large lower jaw. He had presented to a surgeon in his hometown. Realizing that this was a complicated presentation, he was referred to us for surgery for jaw and chin correction.

The mechanism behind Perception of Jaw Size Discrepancy

The disparity in jaw size is a common cause of facial deformity and asymmetry. Either the lower jaw or the upper jaw can be larger than the other jaw. This could be a result of either a large jaw or a small jaw. A small upper jaw could make a normal lower jaw appear large.

Correction of this deformity could either be through jaw reduction or jaw augmentation. Le Fort I maxillary setback reduces the size of a large upper jaw. Bilateral sagittal split osteotomy reduces the size of a large lower jaw. An increase in the size of the lower jaw is through distraction osteogenesis.

Le Fort I osteotomy is the technique of choice for upper jaw advancement. Jaw reconstructive surgery helps correct a variety of deformities, both congenital and acquired. Facial plastic surgeons also perform these surgeries in Japan and other developed countries.

Initial Presentation for Jaw Correction Surgery at our Hospital

Dr. SM Balaji, facial asymmetry surgery specialist, examined the patient. The patient had mandibular prognathism as well as lower facial asymmetry. Treatment planning was formulated and explained to the patient. He was in agreement and consented to jaw reduction surgery.

Specialty Surgical Procedures Performed at our Hospital

Our hospital is a specialty center for facial cosmetic surgery. Facial plastic surgery in our hospital has transformed many lives. Scar revision surgery for burn scars is performed through tissue expansion. We are a specialty center for cosmetic nose surgery in India.

Successful Surgical Correction of Jaw Deformity

Bilateral bone cuts were first made in the mandible. The nerve was safely mobilized with the distal segment. This allowed for free manipulation of the proximal segment. Extreme care was taken to preserve the inferior alveolar nerve during surgery.

A slice of bone 14mm in thickness was removed from the left side. This was followed by a smaller slice of 12 mm being removed from the right to set right the asymmetry.

Occlusion was checked and was found to be normal. The mandible was then stabilized with plates and screws. His facial appearance was transformed following the surgery. He was very happy with the results of the surgery.

His family thanked the surgical team before discharge from the hospital.

5 Points on Facial Asymmetry Surgery – Facial Cosmetic Surgery

A Minor Degree of Facial Asymmetry is Completely Normal

Both sides of the face are near mirror images though it is never a perfect match. There is a minor degree of facial asymmetry even in normal faces. This is how nature works. There is never perfect symmetry of the face or the body. It is this minor asymmetry that adds to the attractiveness of the individual. This asymmetry is however not evident to common people.

Purely Cosmetic Deformity Versus Function Affecting Deformity

It is only when this degree of asymmetry is present to a degree where it is clearly noticeable that it becomes a problem that needs to be addressed. There are two components to the problems caused by this. One is pure cosmetic where it is only the appearance that is affected and not the function. The second is when normal function is affected by the asymmetry.

Procedures for Cosmetic Facial Asymmetry Correction

Procedures like cosmetic rhinoplasty help correct minor imperfections in the face and enhance the appearance of the individual. Many high visibility celebrities undergo such procedures to enhance their facial features for greater career opportunities.

Facial asymmetry normally manifests itself early in life whether it is idiopathic or caused by a medical condition like hemifacial microsomia. Injuries or infections to the developing baby during pregnancy can also result in facial disfigurement.

It can however occur at any stage in life too as a result of trauma or diseases like cancer. Facial asymmetry is very distressing to the affected individual and leads to associated psychological effects like depression and becoming introverted with self-isolation.

Struggles of Mankind through the Ages for Restoring Normal Facial Appearance

Mankind has tried to address this over the ages through various means. For example, World War I was the first truly global war that led to unprecedented levels of facial mutilation. A special unit was created to help individuals who suffered from facial asymmetry due to injuries sustained in war. Facial Plastic Surgery developed rapidly through the efforts of such units.

The Development of Modern Surgical Techniques

Modern surgery has come a long way in addressing the issue of facial asymmetry. Oral and Maxillofacial Surgery as well as Craniofacial Surgery deal extensively with the correction of facial asymmetry and restoration of normal facial features. An example is the treatment of burns scars. Facial scar revision surgery cost depends upon the extent of scarring.

Surgical techniques such as distraction osteogenesis, bone grafting, sagittal split osteotomy, utilization of biocompatible implants and soft tissue remodeling help restore normalcy in the lives of those afflicted with facial asymmetry.

The cost of facial asymmetry correction surgery varies a lot depending upon the severity of the presentation. It can cost anywhere from INR 1-2 lakhs for minor procedures to INR 3-4 lakhs for major facial deformity corrections.

 

Video [Facial Asymmetry Surgery]

OPEN VS CLOSED RHINOPLASTY WHICH TECHNIQUE IS BEST?

OPEN VS CLOSED RHINOPLASTY WHICH TECHNIQUE IS BEST?

OPEN VS CLOSED RHINOPLASTY : WHICH  TECHNIQUE IS BEST?

RHINOPLASTY AS A LIFESTYLE CHOICE TO ENHANCE QUALITY OF LIFE

Open vs Closed Rhinoplasty: Undergoing a nose correction surgery or a nose job is often a life-changing experience for an individual. A rhinoplasty can change a person’s life for the better or the worse. Many show-biz celebrities from around the world have seen their careers soar or collapse as a result of a rhinoplasty.

NEED FOR EXTENSIVE PRESURGICAL COUNSELING REGARDING EXPECTATIONS

Individuals who present for a cosmetic rhinoplasty have certain expectations about the results. It is imperative that they discuss these expectations in detail with the surgeon during the treatment planning phase itself.

TYPES OF RHINOPLASTY FOR NASAL DEFORMITY CORRECTION

There are two types of rhinoplasty procedures, namely open rhinoplasty and closed rhinoplasty. Open rhinoplasty involves making an incision in the soft tissue between the two nostrils. This allows for easy access to the bony and the cartilaginous parts of the nose. Closed rhinoplasty involves making incisions inside the nose.

INDICATIONS FOR CLOSED AND OPEN RHINOPLASTY

Extreme deformities of the nose are addressed through open rhinoplasty. An open rhinoplasty allows for greater manipulation of the structures that give form to the nose. Lesser deformities of the nose are addressed through closed rhinoplasty. There is minor visible scarring from an open rhinoplasty.  There is no scar formation in a closed rhinoplasty as all incisions are made inside the nose.

The recovery period is longer in open rhinoplasty with more postoperative swelling when compared to closed rhinoplasty. This is due to the greater degree of corrections performed through open rhinoplasty.

IMPORTANCE OF EXPERIENCE OF SURGEON IN COSMETIC NOSE SURGERY

Certain cases that have a complicated presentation can be addressed only through open rhinoplasty. Closed rhinoplasty cannot be performed for the correction of deformities in these cases; however, a vast majority of nasal deformities can be set right through closed rhinoplasty. Surgeons with greater experience can correct even large deformities through a closed rhinoplasty while these corrections are approached through an open rhinoplasty by lesser experienced surgeons.

The average cost for open rhinoplasty is Rs 2,00, 000 and the average cost for closed rhinoplasty is Rs 1,50, 000.

Closed Rhinoplasty with Nasal Augmentation – Cleft Lip Deformity

Patient born with a unilateral cleft lip and palate deformity

The patient is a 20-year-old female from Palakkad in Kerala, India. She had been born with a right-sided cleft lip and palate deformity. Her parents had been extensively counseled on the management of an infant with a cleft deformity. They had been referred to a nearby city for surgical management of her cleft deformity.

She had subsequently undergone cleft lip repair at 3 months of age and cleft palate repair at 11 months. A plastic surgeon had performed these surgeries. The patient had subsequently developed speech difficulties for which she had undergone pharyngoplasty. Bone graft surgery is needed if there is a large cleft alveolus deformity.

Worsening nasal defects with the passage of time

As the patient grew up, her nasal deformities worsened. She had a nose that was flattened and asymmetrical. This was a direct result of the collapse of her columella. Her right alar region was also depressed due to a bony defect. Cleft nasal deformities involve both bone and cartilage. They are the most common form of birth defects.

There was prominent scarring from the cleft lip repair surgery. The patient felt that this detracted from her facial esthetics. It was explained to her that a scar revision surgery can be scheduled at a later date to address that.

Surgery for correcting her nasal deformities done elsewhere

The patient had first undergone cosmetic rhinoplasty (nose job) at the age of 14. This was to correct her severely depressed nose, which was also asymmetrical. Multiple cartilage grafts had been harvested and used in this corrective surgery. She had however not been happy with the end results of the surgery.

A couple of years later, she had undergone a redo rhinoplasty at a different hospital. The old grafts had been removed and replaced with new grafts. This had however worsened the appearance of her nose. She does not require open rhinoplasty.

Her nasal deviation had become worse and she developed a whistling sound while breathing. Her alar base depression had not been addressed by either surgery.

The patient feeling despondent and depressed as a result of the two failed surgeries

Feeling extremely upset by the turn of events, she had slowly become depressed and withdrawn. Her academic performance had also become affected by this. Always a good student, she had become indifferent towards her studies. Alarmed by this, her parents decided to get this addressed to the patient’s satisfaction.

Her parents made widespread enquiries and visited a score of surgical centers over the ensuing months. They got in touch with our hospital manager and sent the patient’s photographs for analysis. Convinced that our hospital was the ideal place for this surgery, they decided to come for a consultation.

Premier center for cosmetic rhinoplasty and cleft rhinoplasty correction

We have been addressing patients with nasal deformities for three decades now. Every variety of nasal deformity correction is performed at our hospital. Our hospital is world renowned for cleft rhinoplasty correction.

We have won accolades from the International Cleft Lip and Palate Foundation of Japan. The World Craniofacial Foundation of USA has made us its Southeast Asian regional affiliate.

Initial presentation at our hospital for detailed consultation and treatment planning

Dr. SM Balaji, nasal cosmetic surgeon, examined the patient and obtained a detailed history and imaging studies. The patient-related her dissatisfaction with the results of the two previous surgeries. She had a severely depressed nose that was asymmetrical. There was resorption of the grafts that had been previously placed for nasal augmentation.

The patient’s nose also had extensive transcolummelar intranasal scar formation from the two previous surgeries. Her columella was also buckled with the resultant flat nose deformity. The patient also related her breathing difficulties with the associated whistling sound.

Treatment planning explained to the patient and her parents in detail

It was explained that costochondral grafts needed to be harvested to aid in the correction of her nasal deformities. The depressed alar base needed to be raised by the placement of a graft in the alveolar cleft. A transcartilaginous incision would next be performed for excision of scar tissue. This would be followed by the placement of a graft to raise the bridge of her nose.

The patient and her parents expressed understanding of the treatment plan and consented to surgery.

Successful surgical correction of her nasal deformities using bone grafts

Under general anesthesia, bone grafts were first harvested from the patient. This was followed by a Valsalva maneuver to ensure that there was no perforation into the thoracic cavity. The incision was then closed in several layers using sutures.

Attention was then turned towards raising the depressed alar base. A graft was placed in the cleft alveolus deformity and fixed using titanium screws. The columella was also raised during this portion of the procedure. This resulted in the correction of her depressed alar base deformity.

A transcartilaginous incision was made followed by excision of previous scar tissue. A bone graft was then introduced to give her nose a pleasing straight profile. Her nasal tip was also sharper. All incisions were then closed with sutures.

Total satisfaction with the results of the surgery

The patient and her parents were extremely happy with the results of her surgery. Her breathing was greatly improved

Surgery Video

 

Distractor Removal after Le Fort III Bone Consolidation

Distractor Removal after Le Fort III Bone Consolidation

What is Maxillary distraction osteogenesis?

Maxillary distraction osteogenesis is a surgical technique that prolongs the lower jaw and forces the tongue forward to widen the airway and corrects these problems. Traditionally, babies with this disorder have been treated by tracheostomy, which continues for many years before the infant develops the condition.

Patient born with the classical presentation of Crouzon syndrome deformities

The patient is a 24-year-old female from Manapparai in Tamil Nadu, India. She was born with the abnormal facial features of Crouzon syndrome. Genetic testing is done soon after birth confirmed the diagnosis.

Crouzon syndrome is caused by a genetic defect that leads to craniostenosis. There is the premature fusion of skull bones in this condition. This leads to the development of deformities of the face and skull.

Manifestation of Crouzon syndrome with bony orbital and midfacial deformities

This patient had most of the classical signs of Crouzon syndrome. She had protuberant eyeballs because of deficiency of the orbital bones. There was also a marked regression of the midfacial region. Strabismus was another classical sign that was seen in this patient along with a beaked nose.

Difficulty childhood due to the extreme degree of facial defects in the patient

She had faced a significant degree of bullying at school. Her parents had therefore decided to homeschool her for a majority of her school years. This limited social contact had resulted in her having very few friends. She had always been socially withdrawn and introverted.

Her parents were counseled by a plastic surgeon that she needed surgical correction of her deformities. They had made extensive enquiries regarding the best hospital to address her needs. A social organization that helps patients with facial deformities had referred them to us.

Premier center for craniofacial deformity correction in India

Our hospital is a renowned center for facial deformity surgery in India. We deal with deformities that are both congenital and acquired in nature. Our center is a specialty center for facial trauma surgery in India. Only a few surgeons in India have the experience required to perform complex craniofacial procedures.

Many patients with congenital facial defects arising from syndromic craniostenosis have been successfully treated in our hospital. Distraction surgery is routinely performed here. Facial bones are brought into perfect alignment through craniofacial surgery.

Initial presentation for of syndromic facial deformity surgery in our hospital

Dr. SM Balaji, syndromic craniofacial deformity surgeon, examined the patient. Imaging studies including 3D CT scans were ordered for the patient. He also obtained a 3D stereolithographic model of the patient’s skull. She had all the classical signs including protruding eyeballs, a beaked nose and midfacial retrusion.

He explained that the patient needed midfacial Le Fort III advancement surgery along with internal distraction. A Kawamoto distractor device would be utilized for this. This was due to the extreme degree of midfacial retrusion. The patient subsequently underwent surgical correction of her deformities.

A bicoronal flap was raised followed by bony cuts to the zygoma. The lower part of the orbital bone was then cut for 180 degrees next. This allowed for dysfunction of the bone. Kawamoto distractors were then fixed and checked with trial distraction.

Her frontal prominence was also reduced through the use of a burr. The bicoronal flaps were closed. Maxillary Distraction osteogenesis commenced after the latency period. A total of 15 mm of distraction was performed. There was a complete correction of her midfacial retrusion along with strabismus. This would normalize her eyesight.

Total patient satisfaction with the results of the surgery

They were ecstatic with the results of the surgery. She could see things clearly now and there was a marked improvement in facial esthetics. Her parents were instructed to bring her back in four months for internal distractor removal surgery. This period would allow for bony consolidation at the site of distraction.

Patient returns for removal of internal distractors after four months

The patient and her parents returned for distractor removal surgery. After obtaining imaging studies, the patient was scheduled for distractor surgery. A bicoronal flap was raised and the distractor was removed by unscrewing the screws. Flap was closed using skin staples.

Her skin staples were removed following the complete healing of the incision wound. They were instructed to return in four month’s time for a checkup. She and her parents expressed their complete satisfaction with the results. They thanked the surgical team before discharge from the hospital.

Surgery Video

Jaw Joint Fracture – TMJ Surgery

Jaw Joint Fracture – TMJ Surgery

What is Jaw Joint Fracture (Temporomandibular Joint (TMJ) fracture)

Jaw Joint Fracture or temporomandibular joint (TMJ) factor occurs when the mandible and/or temporal bone is broken near or through the TMJ, the joint linking the jaw bone to the skull. Like other bones in the body, the mandible, also known as the jaw bone, and the temporal bone, the bone on the skull that forms the upper part of the jaw joint, can break when trauma occurs. Fractures of TMJ arise due to direct trauma to the face. The jaw splits most frequently around the condyles, which are rounded projections of the jaw bone. The fracture can also occur when the joints are dislocated.

Young Boy suffers Jaw Injury from Fall at Home

The patient is an 11-year-old boy from Chennai in Tamil Nadu, India. He tripped and fell while playing with friends a few hours ago. His lower jaw hit the ground and he complained of inability to open his mouth fully. There was also mild bleeding from a lower lip laceration.

His parents noticed a deviation of his jaw to the left side upon mouth opening. There was also a grating noise from the left jaw joint. He also complained of facial pain on the left side. There was radiation of pain from his jaw joint to the rest of the face.

Development of facial asymmetry is a feature found in all fractures of the jaws. Movement of the jaw results in worsening of the pain.

Initial Consultation at our Hospital for Management

Fearing that he had a fracture, his parents rushed him to our hospital. Our hospital is a leading center for jaw fracture surgery in India. We are a specialty treatment center for jaw joint fractures.

Our hospital has introduced various innovations related to jaw surgery. These innovations are standard operating procedures in many parts of the world today.

Features of Jaw Surgeries Performed at our Hospital.

Various conditions of the jaws are addressed at our hospital. Jaw reduction surgery and jaw augmentation surgery are also performed at our hospital. Upper jaw augmentation is commonly through Le Fort I maxillary osteotomy.

Lower jaw augmentation is through distraction osteogenesis. Jaw reconstruction is also performed for lesions like tumors and cysts. Our hospital specializes in all types of TMJ surgery. Bone grafts harvested from the patient aid in the reconstruction of jaw deformities. These are most commonly harvested from the ribs and iliac crest.

All these surgeries are performed under general anesthesia. Joint reduction surgery is performed after ensuring all safety precautions. Special safety features have been added in view of the COVID-19 pandemic.

Lower jaw fractures are amongst the most common fractures. Common causes are accidents and assaults. The lower jaw most commonly strikes the ground first when there is a fall. Upper jaw fractures are more associated with assaults and road traffic accidents. They rarely occur from falls.

Children constitute a high proportion of patients with jaw fractures. This is due to their very active lifestyle and physical activity.

Forces are transmitted from the chin to the jaw joint. The chin and the jaw joint are the most common sites for lower jaw fracture.

This can be treated by either open reduction or closed reduction. Closed reduction is utilized in children and in the case of favorable fractures. Open reduction is the preferred choice of treatment in more complex presentations.

Examination and Treatment Planning for the Patient

Dr. SM Balaji, facial cosmetic surgeon, examined the patient and obtained imaging studies. Lower lip laceration was sutured and a diagnosis of left temporomandibular joint condylar fracture was made. There was a medial displacement of the fractured condyle.

This presentation necessitated plate fixation for fracture stabilization. Treatment planning was explained to the parents and they consented to surgery.

Successful Reduction and Fixation of Condylar Fracture

The fracture site was approached through a modified Alkayat-Bramley incision using an endaural approach. The fractured condylar segment was visualized and stabilized using plate and screws. Extreme care was taken to ensure the safety of the facial nerve. There will be no visible scar tissue from the surgery.

Movement of the mandible after plate fixation demonstrated good fracture reduction. The patient recovered without an event from the surgery. He demonstrated good facial nerve function and there were no deficits. He opened his eyes and closed them forcefully as well as demonstrated normal mouth opening.

They were very happy with the level of care at our hospital and expressed total satisfaction. He and his parents thanked the hospital staff before final discharge from the hospital.

Surgery Video – Jaw Joint Fracture Surgery

Fronto orbital Complex Fracture Surgery (Eye level Correction)

Fronto orbital Complex Fracture Surgery (Eye level Correction)

Patient Involved in Road Traffic Accident in his Hometown

The patient is a 46-year-old man from Ajmer in Rajasthan, India. He had been injured in a multi-vehicle road accident around six months ago. There was a direct impact on the left side of his face from a vehicular bonnet.

He had suffered multiple fractures to the bones of the left upper and middle face. Orbital blowout fractures are common in such accidents. There were also serious soft tissue injuries.

Failed Surgery at a Multispecialty Hospital

He had been rushed to a multispecialty hospital in a nearby town for emergent care and treatment. This had been followed by a series of surgeries to correct his deformities. All these surgeries failed and he was left with a gross left-sided facial deformity. There was also malocclusion from the failed surgeries.

Feeling very frustrated, he had approached an organization for help to address this. Having referred patients to us before for facial cosmetic surgery, they sent him to us. They contacted our hospital manager and set up an appointment for him.

Our hospital is a specialty center for redo facial trauma surgery of failed surgeries performed elsewhere. Board-certified plastic and reconstructive surgeons perform such complex surgeries in Western nations. We rehabilitate patients who need complex head and neck surgery

Initial Presentation at our Hospital for Redo Facial Trauma Surgery

Dr. SM Balaji, facial reconstruction surgeon, examined him and obtained a detailed history. A 3D CT scan revealed malunion of his facial fractures from botched surgery. There was malpositioning of the medial wall of orbit fracture.

He also had malunion of his frontozygomatic and front orbital fractures. His left frontal bone had a depressed fracture. Extraocular muscle movement was hampered by the circumorbital fractures.

Multiple Fractures of the Left Facial Region

There was also a blowout fracture of the left floor of the orbit. This had resulted in the lowering of his left orbital contents in relation to the right. A poorly positioned mesh was visualized over his left frontal bone. Malunion of his zygomaticomaxillary fracture had resulted in severe malocclusion.

His speech was also affected by his condition. It was explained to him that all the old plates needed to be removed. The malunited fractures had to be refractured and replated in the correct anatomical position. The patient was in agreement with the plan and consented to surgery.

Refracture of Multiple Malunited Fractures from Previous Surgeries

Access was gained to the left forehead fracture site through the old incision. Plates from previous surgeries were removed. There was a very poor reduction of the front orbital and frontozygomatic fractures.

Resetting Fracture Segments in Correct Anatomical Position

Fracture segments were aligned in normal anatomical positions. The old mesh was also removed. Granulation tissue was excised from the region and bone smoothened with a bur. The old plates from the zygomaticomaxillary fracture fixation were removed.

Occlusion was adjusted and the fracture fragments were stabilized with plates. His old zygomatic arch fracture was also stabilized with plates and screws. It had been unstable after the previous surgery.

This was then followed by a subciliary incision. Access was gained to the orbital floor blowout fracture site. Entrapped orbital contents were released. The medial wall of orbit fracture was addressed next. The detached canthal ligament was reattached with a Y-plate canthopexy. This resulted in a good correction of the fracture.

Next, a titanium mesh with Medpor was used to repair the orbital floor fracture. This resulted in eye-level correction for the patient. A new mesh was then placed over the depressed frontal bone fracture.

Total Patient Satisfaction with Results of Surgery

The surgery resulted in improved facial esthetics as well as functional improvements. The patient tolerated the procedure well. He expressed his gratitude to the surgical team before discharge from the hospital.

Surgery Video

We are dedicated to giving each of our patients the healthy smile they deserve!