Microtia is a congenital condition in which there in poor development of the ears. Correction involves staged reconstruction of the ear using autogenous costal cartilages. A template is utilized to create the form of the proposed external ear. Three surgeries complete reconstruction of the microtia affected ear.
Patient presents to our hospital for specialized microtia surgery
This is a young 13-year-old boy from Tirupati, Telangana with microtia. His parents brought him to our hospital for bilateral microtia repair. Dr SM Balaji, microtia repair specialist, explained the surgery to them. They agreed to proceed with surgery.
Microtia surgery of bilateral ears performed for young boy from Tirupati
After general anesthesia, rib grafts were first harvested. Grafts obtained were from the fourth, fifth and sixth ribs. A Valsalva maneuver was then performed. This was to rule out accidental perforation into the thoracic cavity. Using a metal template, the sixth rib graft was first carved and sculpted to form the external ear framework. This was done for both the right and the left sides. The other graft pieces were then fixed and secured with nonresorbable sutures. Care was taken to maintain symmetry between the frameworks of both ears.
The skin of the right ear was first incised and underlying tissues dissected to create a pocket. The framework of ribs was then tunneled into the pocket. Skin was then sutured and surgical drain placed at the site. This step will help adapt the skin to the cartilage framework. The left ear was then addressed.
Second stage repair will be after about 3 months. This will be for elevation of the framework inserted in the first stage.
This young man from Arani in Tamil Nadu never liked his nose. He had already undergone rhinoplasty elsewhere. They had used cartilage graft from the ear. Following surgery, he still felt that his nose was very broad and flat. He desired corrective surgery and presented to our hospital for management.
Patient consents to surgery after treatment plan explained
Dr SM Balaji, rhinoplasty specialist examined the patient. He explained the treatment plan in detail to the patient. This involved harvesting a rib graft. The patient consented to surgery.
Harvesting of rib grafts for nasal bridge augmentation
Under general anesthesia, a rib graft was first harvested from the patient. A Valsalva maneuver was then performed to confirm patency of the thoracic cavity. The incision was then closed in layers.
Correction of saddle nose deformity through rhinoplasty
Attention was then turned to the saddle nose deformity. A transcartilaginous incision was first made. Tunneling was then done to the bridge of the nose. The rib graft was then inserted to augment the bridge of the nose. Attention was next turned to the broad ala. An elliptical incision was then placed in the right alar crease. Excess tissue was next excised from this region and the incision sutured.
The patient expressed complete satisfaction at the results of the surgery.
Patient presents to our hospital for nose asymmetry correction
The patient is a young man who had undergone cleft surgery in our hospital as an infant. He now presents for correction of nasal asymmetry and scar revision surgery.
Treatment planning explained in detail to the patient
Dr SM Balaji examined the patient and explained the treatment planning to him. He explained that harvesting a rib graft was necessary for this surgery. The patient consented to this and agreed to the surgery.
Successful rhinoplasty and cleft lip scar revision surgery
Under general anesthesia, a rib graft was first harvested from the patient. A Valsalva maneuver was then performed and demonstrated a patent thoracic cavity. The incision was then closed in layers.
Attention was next turned to the rhinoplasty surgery. Intranasal incisions ensured absence of visible scar formation. Medial osteotomy of the nasal bone was then done. The spreader graft was then placed. Following this, the rib graft was then shaped and tunneled to the bridge of the nose. This established symmetry of the nose.
Attention was next turned to the scar from the previous cleft lip surgery. The scar was then incised and skin edges sutured using fine sutures.
The patient expressed his satisfaction at the results before final discharge.
Patient with deficient maxilla presents for augmentation surgery
The patient is a middle aged man from Waltair. He had undergone an endoscopic surgery for clearance of maxillary sinus rhinosporidiosis. A complete maxillary resection was performed previously at our hospital to remove all affected bone and bone affected by osteomyelitis. A reconstruction was done using the remaining bone. This resection however led to a maxillary bone deficiency, causing problems with nutrition and speech. He was then sent for a course of medical treatment of his rhinosporidiosis with complete resolution of his infection. He then presented to our hospital for definitive management of his problems.
Rhinosporidiosis treated with full resolution
Dr SM Balaji, facial reconstruction specialist, examined the patient. A biopsy was first obtained from the mucosa. Once it was confirmed that there was complete resolution of his fungal infection, the patient was then scheduled for surgery.
Maxillary augmentation surgery performed with bone grafts
Under general anesthesia, a rib graft was first harvested from the patient. A Valsalva maneuver was then performed to confirm patency of the thoracic cavity. The incision was then closed in layers.
Successful completion of maxillary augmentation surgery
Attention was next turned to the maxilla. A mucoperiosteal flap was then raised and plates from the previous surgery removed. Pieces of rib graft were then fixed at the deficient regions. This aided in augmenting the deficient maxillary bone. Once adequate augmentation was performed, the flap was then closed using sutures. Implants at a later date will complete oral rehabilitation of the patient.
The patient expressed his happiness at the progress of his treatment. He expressed his gratitude at the successful completion of the first phase of treatment.
The various causes that lead to partial or complete facial paralysis
Facial paralysis means loss of facial movements due to nerve damage. It usually affects only one side of the face. The muscles on that side weaken and appear to droop. Causes of facial paralysis include infection, injury, tumor or stroke.
Patient presents to the hospital for treatment of long standing facial paralysis
This lady from Kurnool has had drooping of the left side of the mouth for a long time now. This caused problems with both eating and speech. There has also been constant drooling of saliva on that side. Her family’s search for the best facial reanimation surgeon led them to our hospital.
The patient examined thoroughly and treatment planning explained
Dr SM Balaji examined the patient. Diagnosis was lower motor neuron facial paralysis of the left face. Treatment planning was then explained to the patient. This would involve static reanimation using fascia lata sling graft. The patient agreed to the treatment plan and was then scheduled for surgery. A fascia lata sling operation is a static procedure done to improve the symmetry of the mouth. It is the most preferred material for sling because it is tough enough to support the mouth. More than one strip can be also taken for creation of different vectors to aid in suspension.
Surgical procedure of static suspension with fascia lata strip for facial reanimation
Under general anesthesia, a fascia lata strip was first harvested from the thigh. The incisions were then closed with sutures. An elliptical incision was then made in the right nasolabial fold. Another small incision was then made on the right zygomatic arch. A tunnel was then created below the skin. The fascia lata strip was then tunneled through to the zygomatic arch. It was then sutured to the atrophic orbicularis oris to act like a sling for the modiolus.
Lateral tarsorrhaphy also performed to establish good facial symmetry
This procedure created symmetry of the lips, corners of the mouth and laugh lines. Lateral tarsorrhaphy was then done to for partial closure of the eyelids. This would ensure that the patient was able to close her eyelids. Good facial symmetry resulted from these procedures.
The patient expressed her happiness at the results before final discharge from the hospital.
Patient with painful lumps under his tongue presents for treatment
The patient is a middle aged male from Cuttack. He stated that he had felt two hard lumps under his tongue. This has been causing pain for around two years now that increases while eating. He presented to our hospital for definitive management and treatment.
A diagnosis of sublingual salivary calculi confirmed through studies
Dr SM Balaji examined the patient and ordered diagnostic studies. A 3D sialogram and OPG demonstrated presence of two sublingual salivary duct calculi. Palpation of the region revealed two hard masses in the left sublingual duct. Treatment planning was then explained to the patient who agreed to the surgery.
Successful removal of salivary calculi with uneventful healing
Under adequate general anesthesia, the opening to the Wharton’s duct was first identified. Gentian violet was then injected into the duct to fix the position of the calculi. The calculi were first palpated to confirm their location. A small incision was then made at the orifice of the salivary duct. The two calculi were then manipulated and teased out of the duct. This would ensure uninterrupted flow of saliva after healing.
The patient recovered from general anesthesia. Postoperative healing was uneventful and salivary flow was normal and at optimal level. The patient expressed his gratitude before final discharge from the hospital.
