Importance of Jaw Reconstruction surgery following Trauma

The jaws play a very important role in the maintenance of overall good physical and mental health. They give form to both the middle face and the lower face. Good symmetrical jaw structure plays a vital role in the holistic well-being of the person. They not only aid in speech and eating but are also vital for the esthetics of the facial region.

When this balance is disrupted either through disease or trauma, reconstructive surgery helps in reestablishing normalcy. Reconstruction of the upper jaw and lower jaw are exacting surgeries, which require a high level of skill. Experienced facial plastic surgeons provide the best results for jaw reconstruction surgery.

Role of Oral and Maxillofacial Surgeons in Facial Plastic Surgery

Oral and maxillofacial surgeons specialize in surgeries of the maxillofacial complex. They undergo a specialized training that involves cosmetic, trauma and cancer surgeries. Facial plastic surgery is also performed by them. Experienced surgeons of this specialty obtain the best results from jaw reconstruction surgery.

Treatment Modalities in Jaw Reconstruction Surgery

Various treatment modalities have been developed over the years for performing jaw reconstruction surgery. They include the usage of bone grafts and rh-BMP2, distraction osteogenesis, Le Fort osteotomies and sagittal split osteotomies. The best surgeons are able to visualize the final results beforehand and plan the surgeries accordingly.

Conditions that Require Jaw Reconstruction Surgery

Jaw structure can be compromised due to a variety of factors. They include pathological, trauma and developmental. All these causes lead to a compromise in the overall quality of life for the patient. Modern surgical techniques have advanced to the point where the compromised jaw structure can be corrected through jaw reconstruction surgery.

Bilateral sagittal split osteotomy is performed for the receded lower jaw. Correction of craniofacial anomalies including orthognathic surgery is performed by Craniofacial surgeons. Cleft palate repair and cleft lip repair are performed by facial cosmetic surgeons. These are congenital defects present at birth.

Mandibular osteotomy is performed to reduce an oversized lower jaw. This is a form of corrective jaw surgery. Surgery is performed through small incisions made intraorally. Many of these cases require orthodontic treatment before and after surgery for fine-tuning of occlusion. Plates and screws are used to stabilize the site of the osteotomy.

Many pathological processes lead to compromise in the structure of the jaws. The tumours and cysts like ameloblastoma, odontogenic keratocysts, dentigerous cysts and osteosarcomas. Conditions such as hemifacial microsomia, congenital micrognathia and fractures caused by trauma also lead to jaw deformities.

Jaw Reconstruction Surgery as a part of Facial Plastic Surgery

Jaw reconstruction surgery is only one aspect of facial plastic surgery. Rhinoplasty, scar revision surgery, microtia surgery, facial asymmetry surgery and facial reanimation surgery also form a part of facial plastic surgery. All these surgeries are technique sensitive and take years of dedication and hard work to master.

Medical Tourism Destination for Jaw Reconstruction Surgery

Our hospital is a premiere center for facial plastic surgery in India. We are a super specialty surgical center for jaw reconstruction surgery. Our hospital has been a destination of choice for patients coming for facial surgery from around the world. We offer world-class services at a very nominal cost compared to hospitals in the developed nations.

Our hospital has won numerous awards for providing good results consistently for over three decades now. We are the affiliate surgery center for many international foundations around the world. This has been made possible by the dedication and hard work of Dr. SM Balaji. It is the result of his vision to provide world-class treatment in a third-world setting.

Extensive Facial Deformities due to Road Traffic Accident

The patient is a 36-year-old male from Raipur in Chattisgarh, India. He was involved in a horrific multivehicle road traffic accident a few years ago. This resulted in extensive panfacial fractures, which left him with extensive facial deformities and functional compromise. He had suffered frontal, orbital, zygomatic, maxillary, and mandibular fractures.

He has undergone multiple surgeries in several hospitals in the past, but none of these surgeries were successful. They had resulted in worsening of his functional difficulties and facial esthetics. He had subsequently become depressed as the surgeries only compounded the problems caused by the road traffic accident.

Referral to our Hospital for Surgical Management of Facial Deformities

Realizing that the problem had to be addressed, his family conducted extensive inquiries for the best hospital to treat him. Many of the doctors they contacted referred them to our hospital. Convinced that our hospital was the best surgical center to address his problems, they presented to our hospital for an initial consultation

The treatment plan for surgical management of facial deformities caused by the previous surgeries was presented to them. It was explained that this would involve multiple surgeries that had to be spaced to obtain the best results. They were informed that the first surgery would be maxillary reconstruction using rib grafts harvested at the time of surgery.

Successful Reconstruction of Maxilla with Rib Grafts

He underwent successful reconstruction of the maxilla using rib grafts that were crafted to reconstruct the bony defect. There was a complete failure of the rib graft that had previously been placed in his hometown. The new rib grafts resulted in symmetry with the contralateral side of his maxilla.

It was explained to them that this was just the first step of his rehabilitation. He would need to return in four months for a zygoma implant following the consolidation of rib graft with the surrounding bone. The facial asymmetry that had resulted from the previous surgeries would be corrected by a series of surgeries.

Total Patient Satisfaction from Treatment at our Hospital

There was total patient satisfaction with all his family members expressing their happiness at the results of the surgery. They expressed understanding that they had to return in four months for the next surgery. The patient and his family thanked the staff before discharge from the hospital.

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Unilateral Cleft Lip Repair for Children with Cleft Lip Deformity

Cleft lip deformity can occur with varying severity. It can range from very mild to very severe. Most severe is the bilateral cleft lip and palate deformity. There is also a hole in the roof of the mouth in the upper jaw. The mildest form is the unilateral incomplete cleft lip deformity.

Ear infections are common in these children. The infection is transmitted through the Eustachian canal. These infections are controlled once the surgical repair is performed. Hearing problems subside following surgery.

The mildest form of cleft lip deformity is unilateral cleft lip deformity. It involves only one side of the lip and does not involve the alveolus or the palate. Unilateral cleft lip repair is the only surgical repair required for these children. The upper lip and nose is affected in cleft lip deformity.

Ramifications of Bilateral Cleft Lip Deformity on Quality of Life

The most severe manifestation of the deformity is the bilateral cleft lip and palate deformity with a free-floating premaxillary segment. A bilateral cleft lip deformity not only affects the esthetics but also the functional aspects of eating and speech. Rehabilitation for patients is usually lengthy and involves undergoing multiple surgical procedures.

First Attempts at Cleft Lip Surgery in Antiquity

Children born with cleft lip deformity often faced a very difficult life during ancient times. The Chinese were the first to attempt a rudimentary cleft lip surgery. Results from the surgery were varied with some very good results at times. History records a member of a royal family with a cleft lip deformity who had undergone successful surgical correction.

Reaction to Cleft Lip Deformity in the Ancient Past

Scientific temper developed only over the last 500-600 years around the world. The Renaissance played a very important role in developing the correct mindset towards life. Children born with a cleft lip deformity were viewed with suspicion in the ancient past. People associated them with the occult and rejected them.

Role of India in the Development of Facial Plastic Surgery

Susruta who is considered to be the father of facial plastic surgery lived in ancient India. Cutting off of the nose was a common punishment meted out to criminals. He was the first to advocate the use of forehead flaps for the reconstruction of nasal deformities arising from such punishments.

Rehabilitation of Cleft Lip Deformity through Modern Surgery

It was only after the advent of the modern age that cleft lip deformity correction was performed with finesse. Postsurgical scarring is also minimal with good esthetic and functional rehabilitation. Experienced surgeons offer very good results with complete patient satisfaction. Plastic surgeons also perform this surgery.

Lengthy Rehabilitation following Cleft Lip Surgery

When the cleft lip and palate deformity is severe, it often involves a lengthy rehabilitation. It involves undergoing a series of surgery to attain normalcy. The first is cleft lip surgery, which is performed at 3-1/2 months of age. This is followed by cleft palate surgery at 10 months of age.

The third surgery is the closure of the cleft alveolus at 4-1/2 years old through the use of bone grafts. This is followed in later years with maxillary advancement, scar revision and other such surgeries as needed. Speech therapy is also an integral part of the rehabilitation of cleft lip patients.

Experienced surgeons offer the best results for cleft lip surgery. The alar base also needs to be reconstructed. They are adept at molding the delicate soft tissue structures of the cleft lip and palate. It is not only a surgical science but also an art that involves an artistic eye for symmetry and proportions.

Center for Excellence in Facial Plastic Surgery and Cleft Lip Surgery

Our hospital is a renowned center for cleft lip surgery for over three decades now. We have been offering our services to patients from around the world. Many patients from Western nations including USA, UK, Germany and France come to us for facial plastic surgery.

We are the only Indian affiliate of the International Cleft Lip and Palate Foundation (ICPF) of Japan.  Our hospital is also the only Asian affiliate of the Dallas-based World Craniofacial Foundation (WorldCF) of the USA.

Baby Girl born with Unilateral Cleft Lip and Palate Deformity

This infant is from Shimla in Himachal Pradesh, India. She was born with a wide unilateral cleft lip and palate deformity. Her parents requested that they wanted the best treatment for their baby. They were then referred to our hospital for cleft lip surgery.

Initial Consultation and Treatment Planning in our Hospital

The treatment planning was explained to the parents in detail. They were given the “Advanced Treatment for Cleft Lip and Palate.” This is a concise handbook for parents authored by Dr. SM Balaji. Her parents expressed understanding of the same and consented to surgery

Successful Surgical Correction of her Cleft Lip Deformity

Surgery is performed under general anesthesia. She underwent cleft lip surgery at the age of 3-1/2 months. The floor of her nose and nasal sill were rebuilt with a C-flap. A meticulous approximation of the cleft lip was then performed in a three-layer closure. The structures of the lip to include the orbicularis oris, subcutaneous tissue and skin were perfectly aligned using a surgical loupe.

There were very good function and esthetic results from this surgical technique. Her parents were instructed to return when she was 10 months old for cleft palate repair. They expressed understanding of the instructions and thanked the hospital staff before discharge.

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Development, Occurrence and Etiology of Odontogenic Keratocyst

Odontogenic keratocysts are benign developmental cysts, which cause extensive destruction of bone. The most commonly arise from the epithelial cell rests of the dental lamina. The most common affection region is the posterior region of the lower jaw. The presentation can be unilocular or multilocular in appearance.

These lesions have a preponderance for males and are most common in the 40-60 age group. Males are affected at a ratio of 2:1 when compared to females. They very rarely occur in the maxillary bone. There is localized pain and swelling at the site through the incidental radiographic diagnosis is common for this cyst. Gum tissue appearance is normal.

Treatment is through surgical resection of the lesion. The affected jawbone most often requires reconstruction as there is extensive destruction of bone by the lesion. It takes years of experience to gauge the amount of bone that needs to be removed during jaw cyst surgery. We have been addressing such lesions in our hospital for over 30 years now.

Voted the Best Jaw Reconstruction Hospital in India

Dr. SM Balaji, jaw cyst surgery specialist, has over three decades of extensive experience dealing with a variety of cysts. We have been recognized as the best jaw reconstruction hospital in India by our peers. This recognition has been achieved through consistent delivery of surgical excellence over the years.

We use a variety of modalities for performing jaw reconstruction. They include the utilization of grafts harvested from the patient. Consistent results and successful rehabilitation of patients have earned us the reputation of being the best jaw reconstruction hospital in India. We give importance to the establishment of overall oral health in our hospital.

Jaw reconstruction surgery is a specialty procedure performed at our hospital. Conditions such as open bite are addressed through surgery as well as orthodontic treatment in our hospital. We are a leading hospital for oral surgery in Chennai. We also have a well-equipped dental clinic in our hospital that addresses issues such as tooth decay.

Our hospital is a super specialty center for jaw cyst surgery and jaw reconstruction surgery. We have dealt with a wide variety of jaw lesions including dentigerous cysts, odontogenic keratocysts, ameloblastoma and various other conditions.

Our hospital is a leading center for orthognathic surgery in India. A recent pan Indian survey by a leading newspaper named us as the best jaw reconstruction hospital in India.

Patient Develops Swelling and Pain in the Lower Jaw

The patient is a 26-year-old male from Chalakudy in Kerala, India. He began noticing a slight swelling in the left lower jaw around a year ago. This began progressing further and he soon developed pain and tooth loosening at the site of the swelling. Alarmed over the events, he visited a local hospital.

Imaging studies and a biopsy were obtained at the hospital. Biopsy results came back positive with the diagnosis of odontogenic keratocyst in the left mandibular region. Treatment planning was explained to him and he consented to surgery.

The cyst was enucleated and the infected bone was debrided. There was a recurrence of the cyst in a few months and he underwent a second surgery. The second surgery was also unsuccessful with a resultant pathological fracture at the left parasymphyseal region.

He immediately presented again to his doctor in his hometown. Diagnostic studies were performed and revealed not only the fracture but also the recurrence of the lesion again. There was constant minor bleeding at the site of the surgery. Realizing the complexity of the presentation, they referred him to our hospital for management.

Initial Presentation at our Hospital for Surgical Management

Dr. SM Balaji, jaw cyst surgery specialist, examined the patient and obtained imaging studies. This demonstrated that there was a recurrence of the lesion along with a pathological fracture of the mandible. He explained that the patient needed to undergo removal of the recurrent lesion. This would be followed by jaw reconstruction surgery and subsequently by dental implant surgery.

This line of treatment would result in complete rehabilitation for the patient with the restoration of complete normalcy. The patient was in full agreement with the treatment plan and consented to surgery.

Surgical Resection of the Recurrent Odontogenic Keratocyst

Under general anesthesia, rib grafts were harvested from the patient to be utilized for jaw reconstruction. A Valsalva maneuver was performed to ensure that there was no perforation into the thoracic cavity. The incision was then closed in layers with sutures.

Attention was next turned to the odontogenic keratocyst. The patient’s recurrent lesion was resected in its entirety. The bone was debrided to reveal the fresh healthy bone. Harvested rib grafts were carefully crafted to fit into the bony defect in the mandible.

There was good recreation of bony anatomy at the site of the bony defect. The bone grafts were then fixed to the mandibular bone with titanium screws.

Patient Returns in Four Months for Dental Implant Surgery

As instructed at the time of previous surgery, the patient returned in four months for dental implant surgery. Imaging studies revealed complete consolidation of the bone grafts with underlying mandibular bone. The long-term prognosis for this patient is very good.

There was a reestablishment of a good mandibular contour at the site of the surgery. The titanium screws that were used to fix the grafts were removed. This was then followed by the fixation of premium dental implants to the alveolar bone. Removable dentures are a poor substitute for dental implants.

The patient was instructed to return in six months for fixation of ceramic crowns to the dental implants. These replacement teeth (artificial teeth) will be perfectly shade-matched to his natural teeth. This period would allow for complete osseointegration of the implants with the alveolar bone.

The patient expressed understanding of the instructions and expressed his happiness at the standard of care in our hospital.

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What is an Odontome and how is it formed?

An odontome is a benign tumor, which is linked to the abnormal development of a tooth. It is a hamartoma and is composed of irregularly placed normal tissue. This can involve both hard tissue as well as soft tissue. Odontoma was the previously used terminology for an odontome.

Most Frequently Diagnosed Age Group for Odontome

This condition is most commonly diagnosed during the early teenage years. It is most commonly incidentally diagnosed when there is a delayed eruption of a tooth. Odontomes are frequently associated with unerupted teeth. They are rare instances of eruption into the oral cavity.

Extraction of the unerupted odontome is the usual treatment of choice. This is akin to surgical removal of impacted third molars. Impacted mandibular odontomes are usually found deeper in the jawbone, being in close proximity to the inferior alveolar nerve. An improper surgical technique can lead to damage to the nerve.

Successful extraction of an impacted mandibular odontome requires a lot of experience. The best possible results are obtained by surgery performed by experienced oral and maxillofacial surgeons. Oral surgery is one of the specialties of dentistry. Our dental clinic in Chennai is a premiere center for oral surgery.

Hard Earned Reputation as the Best Wisdom Tooth Hospital In Chennai

Dr. SM Balaji, Oral and Maxillofacial Surgeon, has over three decades of experience in dealing with the extraction of impacted teeth. Our hospital is considered to be the best wisdom tooth surgery hospital in Chennai. We perform chair-side wisdom tooth surgery for simple cases. Extraction of complicated impacted wisdom teeth is performed in the operation theatre under general anesthesia.

Our expertise in ensuring the best possible surgical results for patients is hard-earned. This has earned us the title of best wisdom tooth surgery hospital in Chennai from both our peers and patients alike. We handle the most complicated cases of impacted wisdom teeth. They even present near the lower border of the mandible as well as near the orbital cavity.

We have been named the best wisdom tooth surgery hospital in Chennai by a recent survey by a leading newspaper. The survey has also named us as being the best wisdom tooth surgery hospital in India. This high honor has been made possible by our commitment to excellence and ensuring total patient satisfaction.

Best Tooth Extraction Hospital in Chennai

Our hospital is amongst the leading dental hospitals in India. We are the destination of choice for the best dental treatment in Chennai. Many patients come from around the world for dental treatment at our hospital.

Our hospital is equipped with the latest technological advancements to offer the best possible treatment for our patients. The dental services provided by our hospital are amongst the best in the entire nation. We are a tertiary centre for specialized world-class dental care in India.

Patient Presents to our Hospital for Definitive Treatment of Odontome

The following case is a description of a patient who came to our hospital for treatment of an odontome. There was also compression of the inferior alveolar nerve by the odontome. The odontome was extracted with minimum trauma along with an associated impacted tooth. There was no compromise of nerve function following the surgery.

Failure of Initial Treatment Elsewhere for the Patient

The patient is a 25-year-old female from Gingee in Tamil Nadu, India. Around 18 months ago, she had presented at a local hospital with pain and mild swelling in her mouth. This was at the site of a missing first molar tooth on the right side of her lower jaw. Imaging studies had been obtained, which revealed an impacted first molar and a partially formed second molar.

There was a radiopaque shadow around the second molar. The second molar tooth was in close proximity to the inferior alveolar nerve. This was diagnosed as an odontome and extraction were recommended to the patient. However, the attempt to extract the two teeth was abandoned midway with the removal of the crown of the impacted first molar. There was no occurrence of a dry socket.

The patient was advised to seek treatment at a superspecialty center, but failed to do so. It was only 18 months later that the patient presented to our hospital. The swelling and pain with paresthesia at the site of the attempted extraction forced her to address this.

Initial Presentation and Treatment Planning at our Hospital

Dr. SM Balaji, Wisdom Tooth Impaction Surgeon, examined the patient and ordered imaging studies. This revealed the first molar with the missing crown and partially formed the second molar. The second molar was diagnosed as an odontome.

There was also a draining sinus at the site of the attempted extraction. Compression of the nerve by the odontome was diagnosed as the cause for her paraesthesia. Treatment planning was explained to the patient and her attendants in detail. She expressed understanding and consented to undergo surgical removal of the impacted teeth.

The patient was taken to the operating room and anesthesia was induced. Prepping and draping were done to have the wisdom tooth removed. Tooth removal was preceded by an incision of the gum tissue overlying the region. The impacted wisdom tooth was then exposed following removal of overlying bone.

Both teeth were then extracted followed by debridement of granulation tissue at the site. There was a complete resolution of the patient’s complaints following surgery. A rib bone graft harvested at the time of surgery was used to reconstruct the bony defect at the surgical site. This was fixed with titanium screws.

Postoperative instructions were given to the patient. She will return in six months following complete consolidation of the bone graft with surrounding alveolar bone. Dental implant surgery would be performed at that time with the placement of premium dental implants. Ceramic crowns would be fixed to the dental implants following osseointegration of the implants to the mandibular bone.

The patient was very happy with the level of care at our hospital. She also expressed a complete understanding of the instructions given by hospital staff before discharge from the hospital.

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