A 25-year-old girl from Mumbai reported to our hospital with complaints of forwardly placed upper and lower jaw. The patient also complained about her gummy smile. She had difficulty in closing her mouth and was very self-conscious of her looks.
Radiographic analysis of the facial bones showed that she had a prognathic maxilla and mandible. Maxillofacial surgeon Dr. S.M. Balaji planned to perform Lefort I osteotomy followed by subapical osteotomy. The excess bone from the upper jaw was removed & the jaw was set backwards and upwards in proper alignment with the lower jaw. The anterior portion of the lower jaw was setback using Kole’s technique. The results were spontaneous and she was overjoyed with her new look.
Patient with prognathic maxilla and short upper lip presents for surgery
This young man presented with a vertical excess of the prognathic maxilla. It resulted in the shortening of the upper lip with inability to appose the lips. This was causing social problems for the patient. He presented to our hospital for surgical correction of his problem.
Treatment planning explained to the patient
Dr SM Balaji examined the patient and ordered imaging studies. On cephalometric analysis, it was found that he had 7 mm vertical excess of maxillary bone. He explained the treatment plan to the patient who agreed to it.
Successful Le Fort I surgery with optimal results for the patient
Under general anesthesia, a Le Fort I maxillary osteotomy was performed initially. The maxilla was then disengaged from the facial bone. A 7 mm strip of maxillary bone was removed in the horizontal plane. The disengaged maxilla was then repositioned superiorly with two X-plates and screws. Occlusion was then checked and found to be perfect. The incision was then closed with sutures.
The patient expressed his complete satisfaction at the results of the surgery.
Patient who hated his small jaw presents to our hospital
This young man from Australia never liked his retruded chin. It caused him to have a double chin. He had always wished to have a more prominent mandible. His quality of life was also affected by this. The patient had enquired all over Europe, but the costs there were prohibitive. Being a medical doctor himself, he researched the Internet for a quality oral surgeon. His Internet search led him straight to our hospital. He got in contact with our hospital manager who arranged for his travel to India.
Treatment plan explained to the patient
The patient met with Dr SM Balaji who obtained a detailed history from him. He was very particular that he wanted advancement through distractors. This was because he wanted to monitor for himself the changes as the distractors were activated each day. A treatment plan was then formulated and explained to the patient. His double chin would be corrected. He was then scheduled for surgery.
Surgical jaw correction for treatment of double chin
A rib graft was first harvested from the patient. A Valsalva maneuver demonstrated absence of any perforation into the thoracic cavity. The incision was then closed with sutures. Attention was next turned to the retrognathic mandible. A vestibular incision exposed the anterior mandibular bone. The chin was then placed forwards with a vertical augmentation genioplasty. Two L-shaped four holed plates were then used to fix the bones of the chin. The posterior mandible was then osteotomized for placement of the distractors. Mandibular distractors were then fixed with screws and tested.
There was adequate function of the distractors. Bilateral inferior alveolar nerves were carefully protected during the entire procedure. Attention was then turned to the maxilla. Maxillary osteotomy with placement of bone grafts aided distractor placement. Similar distractors were also utilized here. The incisions were then closed with sutures. The distractors were in stable position. 1 mm distraction per day will be next performed until adequate advancement of jaws.
The patient recovered from general anesthesia without any complications. The patient expressed his complete satisfaction with the results before discharge.
Patient presents for maxillary advancement surgery
This young lady had been born with a unilateral cleft lip and palate. She had undergone cleft lip repair at our hospital at the age of 2 months. Cleft palate repair was later performed at the age of 10 months. After this, she had rhBMP-2 surgery for uniting the two pieces of the maxilla into one single bone. The patient now has a hypoplastic retruded maxilla with anterior crossbite. This had been causing her cosmetic problems with a deficient upper jaw. She wanted to have this corrected through surgery. The patient has also been undergoing fixed orthodontic treatment for cosmetic teeth alignment.
Le Fort 1 maxillary osteotomy planned for the patient
Dr SM Balaji is a renowned cleft lip and palate patient rehabilitation specialist. He decided to perform a LeFort 1 osteotomy with maxillary advancement for the patient.
Complete correction of the patient’s crossbite occlusion
Under general anesthesia, a mucogingivoperiosteal flap was first raised in the maxilla. A LeFort 1 osteotomy was then performed. The maxillary bone was then advanced by 2 cm. It was then stabilized in place with four L-shaped four-holed plates. Occlusion was then checked and deemed to be in perfect alignment. The mucogingivoperiosteal flap was then sutured back in place. She would need further fixed orthodontic treatment to perfect her teeth alignment.
Postoperative period was uneventful. The patient expressed her happiness at the results of the surgery before discharge.
The patient is a young woman who had been born with a unilateral right sided cleft lip and palate. She had undergone cleft lip repair as a 2-month infant at Balaji Dental and Craniofacial Hospital. Second surgery was for repair of cleft palate. Stage 3 surgery involved the placement of a bone graft for closure of her alveolar bone cleft. The patient now presents for a LeFort I osteotomy for advancement of her retruded maxilla and for placement of implants for replacement of her missing maxillary teeth. An implant was first placed for replacement of her right maxillary canine. This was then followed by placement of an implant for replacement of her missing first molar.
Attention was next turned towards the LeFort I osteotomy of her maxilla. A gingival mucoperiosteal flap was first raised up to the buccal sulcus. A LeFort I osteotomy was then performed. The entire maxilla was then advanced by 2-3 mm. This resulted in establishment of a Class I occlusion along with correction of her anterior crossbite. The maxillary segment was then stabilized in position with the use of three plates with four screws to each plate. This would aid in stability of her plates during the healing period. Her occlusion was then checked and the teeth were found to be in perfect alignment. The flap was then sutured in place. She recovered well from general anesthesia and was in stable condition.
The patient was very happy with the results of the surgery and expressed the same to Dr SM Balaji. Surgery Video