Patient presents with swelling in the anterior mandible
This patient is a middle aged lady from Villupuram. She first noticed a swelling on the left side of her mandible. This had led to a gradual loosening of the anterior mandibular teeth. An increase in the size of the swelling alarmed her and she went to a dentist. He obtained an x-ray, which revealed a cyst. Suspecting a simple cyst, the dentist had removed the cyst, which had an impacted tooth within it. The swelling however returned and became infected. He then referred her to our hospital for further management.
Biopsy confirms diagnosis of infected dentigerous cyst
Dr SM Balaji examined the patient and ordered diagnostic studies and a biopsy. Biopsy revealed the presence of an infected dentigerous cyst. The patient agreed to surgery after the treatment plan was presented to her.
Rib grafts obtained to fill in area of bony defects after enucleation
Under general anesthesia, two rib grafts were first obtained from the patient. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. The incision was then closed in layers with sutures.
Successful enucleation of dentigerous cyst followed by bone graft
A mucogingivoperiosteal flap was first raised and the region overlying the cyst exposed. The cyst was then enucleated in toto along with the extraction of teeth overlying the cyst. The rib graft was then shaped into pieces to fit into the bony defect. These pieces were then fixed with screws and the flap sutured. The patient recovered from general anesthesia without any complications.
Young man presents for square face reduction surgery
The patient is a young man with a broad face due to large masseter and enlarged gonial angle. He had always been unhappy about this and desired surgical correction. He presented to our hospital to undergo square face correction. Dr SM Balaji explained the treatment plan to the patient who agreed to the surgery.
Square face reduction surgery
Under general anesthesia, a left-sided mandibular vestibular incision was first made. Dissection was then carried down to the region of the gonial angle and masseter. Excess masseter muscle was then removed followed by reduction of the gonial angle. This resulted in adequate reduction of left facial breadth. The same procedure was then carried out on the right side.
The patient is very happy with the results
After adequate reduction had been obtained, the incisions were then closed with sutures. The patient expressed his happiness at the results before discharge from the hospital.
Young lady desiring surgical correction presents to hospital
This young lady is from Madurai. She had always desired a sharp nose. Desiring surgical correction, her family had searched for the best nose correction surgeon. This led them straight to our hospital.
Examination of the nose with detailed treatment planning
Dr SM Balaji examined the patient and recommended costochondral graft placement. This would raise the bridge of the nose and give the patient’s nose a sharp profile. The patient was in agreement with this treatment plan.
Harvesting of costochondral rib graft from the patient
Under general anesthesia, a costochondral graft was first harvested from the patient. A Valsalva maneuver demonstrated absence of perforation into the thoracic cavity. Following this, the incision was then sutured in layers.
Surgical augmentation of a depressed bridge of the nose
Attention was then turned to the nose. All incisions were intranasal to avoid scar formation. The costochondral graft was then crafted to the right size. This was then tunneled to the bridge of the nose and stabilized with sutures. The patient now had a sharp nose with a straight bridge.
The patient expressed her happiness at the results of the surgery before discharge.
This young boy is from Nellore. He has the diagnosis of fibrous dysplasia. Fibrous dysplasia is a disorder of the bone where fibrous tissue develops in place of bone. This weakens bone and can lead to fractures. The patient has this swelling straddling his nose and extending on both sides. His parents brought him to our hospital for reduction of the fibrous tissue. A local dentist referred them here for cosmetic surgery.
Patient examined and treatment plan explained in detail
Dr SM Balaji examined the patient and ordered radiographic studies. Diagnosis was confirmed as fibrous dysplasia. He explained the treatment planning to the parents who agreed to the surgery.
Surgery for fibrous dysplasia done with good esthetic results
A vestibular incision was first made in the anterior maxillary region. Dissection was then done down to the fibrous tissue overlying the nasal region. The fibrous tissue was burred and trimmed until attaining normal facial anatomy. Incision was then closed with sutures. The patient and his parents expressed their satisfaction before final discharge.
Boy with swelling referred to our hospital for treatment
The patient is a little boy from Vadodara. He had complained of a swelling in his left jaw. His parents took him to a local dentist. The dentist suspected this to be a dentigerous cyst. He then referred them to our hospital for management.
Dentigerous cyst confirmed and treatment plan explained
Dr SM Balaji examined the patient and ordered a 3D CT. This revealed a dentigerous cyst with an impacted second molar within it. He advised surgical removal of the cyst and the parents agreed.
Dentigerous cyst enucleated without any complications
Under general anesthesia, a mucogingivoperiosteal flap was first raised. This exposed the bony swelling enclosing the dentigerous cyst. The cyst was then enucleated and removed. Following this, the flap was then sutured back into position. The patient recovered without event from the surgery
A long drawn search for the best facial cosmetic surgeon for this child
This 5-year-old girl from Itarsi was born with a mouth that was very wide on the right side. The medical term for this condition is macrostomia. Her macrostomia and hemifacial microsomia resulted in underdevelopment of her right face. There may be absence of external ear in this condition. Ear tags may be present. The ear tags may contain cartilaginous tissue. If so, they need to be first dissected, repaired and sutured back.
This child will need several surgeries later for reconstruction of the lower jaw. Macrostomia correction is first done and the ear tags removal is then done. She needs complete follow up of growth of mandible on the right side. She also had a tongue tie and ear tags with an extra lobe of the right ear. The tongue tie was causing abnormal speech patterns in the child. Her parents had searched far and wide for the best facial deformity surgeon to correct this. Their search had been futile for many years. It was only around six months ago that they met the parents of a similar child. Surgery performed for that child at our hospital had resulted in perfect correction. This led the parents of this little girl straight to our hospital.
Treatment plan explained to the parents
Dr SM Balaji examined this little girl and ordered diagnostic studies. He explained the proposed surgical plan to her parents. They were in complete agreement with his treatment plan. This was the first stage of surgical correction for this little girl.
Tongue tie and macrostomia correction surgery
Under general anesthesia, the tongue tie was first addressed. The lingual frenum was then dissected free to enable full extension of the tongue. This would enable normal speech for the child. Attention was next turned to the macrostomia correction. The vermillion border on the right side was first dissected. The excess tissue was then removed. The vermillion border was then sutured to ensure symmetry of the lips.
Ear tag and extra ear lobe removal surgery
Attention was then directed to the ear tags and extra ear lobe on the right. The ear tags were first dissected free and excised. The extra ear lobe was also addressed in similar fashion with good esthetic results. Suturing of all incisions completed the surgical procedure.
The patient’s parents expressed their complete satisfaction with the results before discharge.
