Video | Balaji Dental and Craniofacial Hospital

Blowout Fracture – Zygomatic Orbital Complex Surgery with Open Reduction and Fixation of Zygomatic Complex

by smbalaji | Mar 21, 2018 | Surgery, Video

This middle aged man met with a road traffic accident with impact to the left side of his face. He had severe pain and swelling on the left side of his face and was rushed to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai by his family after first aid had been administered elsewhere. Dr. S. M. Balaji examined the patient and ordered a CT scan, which showed a comminuted fracture of his left cheekbone (zygoma) and fracture of the floor of the left orbital bone.

The patient was taken to the operating room and the fracture of the zygomatic complex was approached through a vestibular incision placed in the maxillary buccal sulcus on the left side. A flap was raised and the fracture fragments were carefully stabilized and fixed using plates and screws. The fracture of the floor of the left orbit was next accessed through a transconjunctival approach. The herniated fat and orbital contents were elevated and the titanium mesh that had been adapted to the contours of the floor of the orbit was placed over the fracture site to stabilize it. The mesh was then anchored to the orbital margin using screws. The surgical sites were then closed with sutures. The patient recovered from general anesthesia without complications and was taken to his room in stable condition.

Surgery Video

Lip Reduction Surgery – Dr. S.M Balaji, Balaji Dental and Craniofacial Hospital

by smbalaji | Mar 19, 2018 | Surgery, Video

Lip Reduction Surgery

The patient presented at Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, with the complaint of an excessively large lower lip. She said that she wanted it to be reduced to be proportionate to the upper lip. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, examined the patient and explained the surgical correction procedure in detail. The patient consented and was scheduled for surgery.

Under general anesthesia, the portion of the lip that was to be excised was marked out carefully. Incision was then made along the markings and extended down into the submucosal region. Dissection was carried down into the deeper tissues and excess tissue was excised from the region. Once adequate removal of excess tissue was performed, the vermillion borders of the incision were approximated with sutures. At the two week postoperative visit to the hospital, the patient expressed her satisfaction at the results of the surgery.

Surgery Video

Fibrous dysplasia reduction Osteotomy

by smbalaji | Mar 17, 2018 | Surgery, Video

This lady had been aware for some time now that the left side of her lower jaw was slowly, but surely increasing in size. Since the lesion was painless, she had ignored it for a while. Her family decided that she needed medical intervention and took her to a dentist in their hometown. She was referred by that dentist to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, for management of her problem.

Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, examined the patient and ordered a 3D axial CT scan, which revealed a dense overgrowth in the region, which is characteristic of fibrous dysplasia. This is a disorder of the bone where normal bone is replaced by a scar-like fibrous tissue that leads to weakening of the bone structure. Dr. Balaji explained to the patient and her family that a reduction osteotomy was necessary to restore symmetry to the patient’s face. They were in agreement with this and she was scheduled for surgery.

Under satisfactory general anesthesia, a mucogingival flap was raised distal to the left lower canine and extended to the vestibule to expose the entire fibrous dysplasia lesion. The fibrous bone was then trimmed with high speed drills until perfect facial asymmetry was reestablished. Care was taken to ensure that the mental nerve was protected throughout the surgery. The flaps were then closed with sutures and the patient recovered uneventfully from general anesthesia.

The patient expressed her deep gratitude to Dr. Balaji for restoring symmetry back to her face before being discharged from the hospital.

Paediatric (Child) Rhinoplasty Surgery with Costal Cartilage

by smbalaji | Mar 15, 2018 | Surgery, Video

The patient had a collapsed tip of nose at birth. This particular defect would under normal circumstances be repaired only at a much later stage, but this particular child was being picked on and mocked constantly at school by other children. This distressed the child to a degree that it was affecting her emotional and psychological health. The parents of the child were distressed upon seeing this and approached Dr. S. M. Balaji, Craniofacial Surgeon, Chennai, who upon hearing about the child’s plight decided to perform the surgery on humanitarian grounds.

A costal cartilage graft was first harvested from the right rib cage and the wound was subsequently closed in layers. Following this, the costal cartilage was molded and shaped for graft placement to augment the tip of the nose.

The costal cartilage graft was tunneled along the base of the nasal septum until it approximated the collapsed tip of the nose. Once normal nasal tip anatomy had been reestablished by proper positioning of the graft and normal profile of the nose had been regained, the graft was sutured in place. Following this, the intraoral incision was sutured and closed. Secondary corrections might be needed at a later stage.

The patient and her parents were extremely pleased with the aesthetic results of the surgery.

Oral Submucous Fibrosis, Complete Trismus Release, Excision of Fibrous Bands and Nasolabial Flap Reconstruction

by smbalaji | Mar 1, 2018 | Surgery, Video

Oral Submucous Fibrosis (OSMF) is a pre-cancerous condition seen predominantly in the Indian subcontinent and South East Asia. In this condition, the deep tissues of the cheeks become thick and fibrosed leading to severely restricted mouth opening, referred to as trismus. ]

There is great difficulty in opening the mouth, patients cannot tolerate hot and spicy food, and the cheek lining inside the mouth becomes pale, blanched or marble-like. This is a very serious condition because it has high chances of advancing into mouth cancer (squamous cell carcinoma). The most common cause of this pre-cancerous condition is chewing of tobacco/areca nut.

The patient is a middle-aged man with oral submucous fibrosis who presented to Dr. S. M. Balaji, Craniofacial Surgeon, Chennai with complete trismus as a result of which he couldn’t open his mouth more than a few mm. Upon taking a history, it was found that he had been chewing paan or betel quid containing betel leaf, areca nut, and slaked lime for the past 15 years. The patient also complained of a burning sensation in his mouth. Upon palpating his cheeks, thick, tight bands of tissue could be felt lining his cheeks and he had jaw rigidity. Surgical intervention was the only viable option.

General anesthesia was given through Flexible Fibreoptic Intubation (FFI) since he had very limited mouth opening. Cuts were placed in the inner cheek and the thickened bands of fibrous tissue were excised. Mouth opening was increased to the normal 3-4 cm using a mouth gag. An inferiorly based nasolabial flap based on the facial artery was taken in such a way that the flap margin fell in the skin fold and post-surgery scar is inconspicuous.

The flap was rotated, tunneled into the mouth, and sutured to the inner cheek. The nasolabial incision was closed in layers. This was done on both sides. The patient was prescribed mouth-opening exercises and counseled on complete cessation of the habit.

Dentigerous Cyst Enucleation Surgery

by smbalaji | Feb 28, 2018 | Surgery, Video

This teenage boy had been complaining of pain on the left side of his lower jaw for a few days now. There were a few teeth missing on that side. He was brought to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, by his parents for treatment. Dr. Balaji examined the patient and ordered diagnostic studies including an OPG, which revealed multiple unerupted impacted teeth and a radiolucent area in relation to the lower left first molar. A 3D axial CT scan was ordered and the diagnosis of a dentigerous cyst was made. It was explained to the patient and his parents that this had to be managed surgically and they were in full agreement with that.

The patient was taken to the operating room and general anesthesia was induced. A mucogingival flap was raised and reflected down to the sulcus. The dentigerous cyst was enucleated in its entirely and two unerupted teeth within the cyst were removed. The flap was then sutured and the patient recovered uneventfully from general anesthesia.