Medial blowout fracture correction surgery for orbital volume increase plus ptosis correction by reattachment of levator palpabrae superioris

Medial blowout fracture correction surgery for orbital volume increase plus ptosis correction by reattachment of levator palpabrae superioris

Road traffic accident leaves patient with a sunken left eye

This young woman is from Tirupur, Tamil Nadu. A road traffic accident resulted in injury around the left eye. This had resulted in a blowout fracture of the left eye. Surgery elsewhere resulted in a sunken left eye and residual ptosis. This was the result of fat herniation into a medial orbital wall fracture. A local oral surgeon referred her to our hospital for surgical correction.

Treatment planning explained to patient and consent obtained

Dr SM Balaji, facial deformity correction specialist, examined the patient. He explained that the sunken eye was due to herniated fat. The patient also needed ptosis correction. He explained that levator palpabrae superioris muscle needed corrective surgery. The patient consented to surgery.

Osteomesh utilized for correction of fat herniation into medial wall fracture

After general anesthesia, the medial wall of orbit fracture was first accessed. Herniated fat was then released from the fracture site. An Osteopor-Osteomesh was then inserted to cover the fracture site. This would form a permanent film over the fracture site. Fat herniation would thus not recur at the fracture site. Fine ophthalmic sutures were then used to close the incision.

Ptosis surgery done with full correction of deformity

The levator palpabrae superioris was next addressed. An incision was first made at the old scar site. The muscle was then accessed and a suture used to attach it to the orbicularis oculi. This incision was also closed with fine sutures.

The patient’s eye function was then tested after recovery from general anesthesia. The patient had symmetrical eyes with correction of the left eye ptosis. The patient expressed her satisfaction before discharge from the hospital.

RTA – Malunited Very old Fracture of Maxilla (Upper Jaw) and Zygoma (Cheekbone) with Enophthalmos Correction Surgery

RTA – Malunited Very old Fracture of Maxilla (Upper Jaw) and Zygoma (Cheekbone) with Enophthalmos Correction Surgery

Young man with residual facial deformities from motor vehicle accident

This young man from Indore, Madhya Pradesh, was riding his bike when he collided with a car 1.5 years back. He suffered facial fractures involving the maxilla, zygoma and orbital region. The patient underwent surgical correction at a local hospital after the accident. This surgery left him with residual deformities. These included an anterior crossbite and a sunken right zygoma with enophthalmos.

The patient presents to our hospital for specialized facial deformity correction

Dr SM Balaji, facial deformity correction specialist, examined the patient. He ordered 3D CT scan and other imaging studies. There were many plates seen from the previous surgery. The maxilla was in a retruded position. He recommended advancing the maxilla forward with a Le Fort I osteotomy for crossbite correction. Other recommended surgeries were refracture of the zygoma with plate fixation. Release of herniated fat trapped in the right eye with Titanium mesh placement was also recommended for enophthalmos. The patient consented to surgery.

Patient undergoes correction of anterior crossbite with Le Fort I maxillary advancement osteotomy

Under general anesthesia, a buccal vestibular incision exposed the old maxillary plates. These were then removed and the maxilla advanced forward with a Le Fort I advancement osteotomy. This resulted in correction of the anterior crossbite. Four L-shaped four holed plates were utilized to achieve this.

Enophthalmos and zygomatic depression correction done for the patient

The enophthalmos and depression in the zygoma were then addressed. A right lateral canthal incision was first made. This was then followed by a right transconjunctival incision. Dissection down into the floor of the orbit exposed the herniated fat under the eye, which was freed. An old plate from the previous surgery was then removed through the lateral canthal incision.

The zygoma was then refractured and repositioned with new plates. This resulted in correction of the depressed zygoma. The enophthalmos was then addressed. A Titanium mesh with Medpor was used to correct it. The Titanium mesh was then fixed with screws to the lower orbital rim. All incisions were then closed with sutures and the patient extubated.

The patient expressed complete satisfaction at the results of the surgery before final discharge.

Surgery Video


Deviated nose correction with cc graft

Deviated nose correction with cc graft

This is a 30-year-old male from Belagavi. He was involved in a road traffic accident. This resulted in a blocked nose with difficulty breathing. He had undergone a nose block clearance surgery elsewhere by open rhinoplasty. This resulted in him developing a deviated nose. There was also residual scars over the bridge of the nose and the columella.
He was very dissatisfied with this and desired corrective surgery. He searched the Internet for the best nose deformity correction surgeon. This led him straight to our hospital.
Dr SM Balaji examined the patient. The patient explained his problem. He said he had great difficulty breathing and that he wished for a more prominent nose. He agreed to the proposed treatment plan.
Surgical correction would be through the use of a costochondral rib graft. The nasal deviation was first corrected by a right lateral osteotomy. The nasal bridge height was then increased. This was by using the graft harvested from the right inframammary region. A small piece of the tissue was next excised from the right supra-alar crease to lift up the right nostril.
The results were immediate and the patient was very satisfied with the results. He expressed his gratitude before discharge from the hospital.

 

Successful surgical correction of diplopia and depressed zygoma

Successful surgical correction of diplopia and depressed zygoma

This is a 23-year-old male from Nagpur. He presented with complaints of diplopia in his right eye and a depression on the right side of the face. He has a history of RTA with emergent treatment of zygomaticomaxillary complex fracture. He was not happy with the outcome of the surgery. His diplopia had not been corrected by the surgery. He then searched the net for the best facial deformity correction surgeon. His search led him straight to our hospital.
Dr SM Balaji examined the patient. The patient had diplopia of the right eye. The diplopia was present only at the extremities of gaze. A 3D CT scan revealed a depressed and malunited right zygoma. Maxillofacial Surgeon Dr SM Balaji planned the treatment. He planned to correct the depression by refracturing the zygoma.
The right malunited zygoma was first exposed by a vestibular approach. The right zygoma was then refractured, elevated and fixed using Ti. plates and screws. The right orbital floor was then reconstructed with a Titan Medpor mesh. This was also fixed using titanium screws. He was very happy with the results of the surgery.

History of RTA operated elsewhere with secondary deformity, DNS correction performed

History of RTA operated elsewhere with secondary deformity, DNS correction performed

History of malunited facial fractures after RTA surgery elsewhere

This young man had suffered injuries to his face with fractures from a motor bike accident. This happened in his hometown a few years ago. He had undergone emergent surgery, which resulted in a malunited nasal bone fracture. His nasal septum was also deviated to the left side. He has been suffering from breathing problems and snoring since then. He decided to get this corrected. A general dentist in his hometown referred him to our hospital for correction of his problem.

Treatment plan explained to the patient

The patient presented at our hospital for management of his multiple facial deformities. Dr. SM Balaji, Cranio-Maxillofacial surgeon examined the patient. He explained the treatment plan to the patient. This also involved harvesting a rib graft from the patient. The patient was in full agreement with the treatment plan.

Deviated nasal septum set right to correct breathing problems

Under general anesthesia, a rib graft was first harvested from the patient. A Valsalva test demonstrated patent thoracic cavity. The incision was then closed in layers. Attention was then turned to the nose. The deviated nasal septum was first refractured. A nasal speculum was then used to widen the nasal choanae. Intranasal incisions were then performed to avoid visible scarring.

Hardware from previous surgery removed

Attention was next turned to the zygomaticomaxillary bone. Maxillary vestibular incisions were then made in the buccal sulcus region. Old hardware from the previous surgery was exposed and removed. Sutures were then used to close the incisions.

Augmentation rhinoplasty performed

The rib graft was next crafted to fit into the bridge of the nose. Graft was then placed through the intranasal incision to fit into the bridge of the nose. This augmented the nasal bridge with precision. All incisions were then sutured.

Nostril breadth reduction surgery performed

Attention was next turned to the nostril reduction procedure for the patient. Crescent shaped incisions were then marked out at bilateral alar bases. The tissue was next incised and removed. The alar bases were then sutured closer to the midline. This resulted in narrowing of the nose.

The patient expressed his utmost satisfaction to Dr SM Balaji before final discharge. He said that his nasal form was back to its original shape.