Young Man Notices Gradual Development of Facial Asymmetry

The patient is a 26-year-old man from Thalassery in Kerala, India. He has had a slowly progressing facial asymmetry for many years now. There was a gradually developing swelling of the right midfacial region.

A biopsy had been obtained and he had been diagnosed with fibrous dysplasia. He had chosen to ignore it as it was not causing him any functional difficulties.

Disfigurement caused by Fibrous Dysplasia and its Probable Etiology

Fibrous dysplasia is a rare disorder of the bone where normal bone is replaced by fibrous tissue. There is an overgrowth of this fibrous tissue, which results in progressive facial disfigurement. The bone is also weakened by this fibrous tissue.

It is thought to result from a genetic mutation at birth but is not hereditary. There is a dull ache in the region of the affected bone. Fractures are also common when it affects the limb bones. The only treatment available is the surgical removal of the fibrous tissue.

Patient Decides to Undergo Surgical Correction of his Deformity

The growth has now progressed to the point where it is causing self-esteem problems for the patient. He was beginning to avoid social interactions because of the extreme facial disfigurement. His parents researched the internet for the best hospital to get this addressed. They also made widespread inquiries regarding the same.

Our hospital is a premiere center for facial plastic surgery in India. Many patients have undergone facial cosmetic surgery and facial reconstructive surgery at our hospital. He and his parents zeroed in on our hospital for his fibrous dysplasia surgery.

Our hospital stringently follows protocols laid down by the American Society of Plastic Surgeons. We also conform to the guidelines laid down by the European Society of Aesthetic Plastic Surgery. Many referrals are made from centers in the European Union to our hospital for correction of facial deformities.

Patients from around the world come to us for reconstructive plastic surgery and facial asymmetry surgery. We utilize advanced facial biometric systems for facial asymmetry correction. Facial implants can be utilized when there is a bony deficiency causing facial asymmetry.

Initial Consultation and Treatment Planning at our Hospital

Dr. SM Balaji, facial cosmetic surgery, examined the patient and spoke with him at length. Biopsies and imaging studies were ordered including CT scans. This revealed a diagnosis of fibrous dysplasia of zygoma and orbit along with the involvement of the temporal bone.

The fibrous overgrowth had caused gross disfigurement of both bones. Our hospital also offers comprehensive imaging services including magnetic resonance imaging (MRI) scan and bone scan.

He explained the surgical treatment process and the cosmetic improvement to the patient. All queries raised by the patient and his family were addressed. The patient and his parents expressed understanding and consented to surgery.

A 3D stereolithographic model of the patient’s skull was obtained. The fibrous overgrowth was studied and presurgical analyses were performed. It was then decided to proceed with surgery.

Surgical Removal of Fibrous Overgrowth

The affected regions of the zygoma and temporal bone were approached through a hemicoronal incision. No other approach would enable satisfactory removal of the fibrous tissue. Surgery progressed through dissection of the galea and temporal fascia. Care was taken to also preserve blood supply to the temporalis muscle to prevent any postsurgical atrophy.

The frontalis and orbicularis oculi branches of the facial nerve were protected throughout the surgical procedure. Dysplastic fibrous overgrowth was removed meticulously. Normal bony contour was established through the removal of the excess tissue. This would restore symmetry to his face.

The fascia was sutured with retraction of the temporal muscle after adequate removal. This was to ensure that there would not be a hollowed-out appearance to the region. The incision was finally closed with staples.

Postsurgical Improvement in Facial Appearance

The patient and his parents were very happy with the results of the surgery. There was a tremendous improvement in the cosmetic appearance of the face. Improvement in the patient’s self-confidence was apparent shortly after surgery.

He and his parents expressed their total satisfaction with the treatment process at our hospital.

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Orbital Dystopia Surgery

One of the most common clinical symptoms of craniofacial malformation is orbital dystopia. The concept dystopia refers to the orbits’ mono- and bilateral asymmetry in at least one of the three-dimensional planes. The clinical examination of the patient is used to make the diagnosis, which is supported by diagnostic instruments such as teleradiography in both normal projections, axial computed tomographic (CT) scans at a rate of 1:1 via the neuro-orbital plan, and three-dimensional CT.

A young man with Grievous Facial Injuries from Road Traffic Accident

This is a 24-year-old man from Ranchi in Jharkhand, India. He had been involved in a horrific road accident. There was also blindness caused by the loss of his left globe. This had resulted in left-sided facial fractures involving his middle facial region. These fractures involved many bones causing asymmetry.

There was the involvement of his orbital bone, nasal bone, zygoma and maxilla. He had undergone a series of surgeries in various hospitals. These had left him with a facial asymmetry and severe orbital dystopia.

He descended into a depression because of the turn of these events. His worried parents had consulted far and wide for the best hospital to address his problems. They were referred to our hospital by a leading plastic surgeon in their hometown. They contacted our hospital manager and fixed an appointment for a consultation.

Board-certified facial cosmetic surgeons perform these surgeries in Western nations. Oral and Maxillofacial surgeons who are also cosmetic surgeons perform these in India.

Leading Center for Facial Trauma Surgery In India

Our hospital is a leading center for redo facial trauma surgery in India. Many patients with complications arising from surgery performed elsewhere present to our hospital. Our hospital serves as a tertiary referral center for craniofacial surgery in Asia.

We are a specialty center for prosthetic eyeball surgery in India. Our in-house prosthetic laboratory provides custom-made shells to many centers around the country.

Specialty Center for Redo Facial Cosmetic Surgery

Dr SM Balaji, facial cosmetic surgeon, examined the patient and obtained imaging studies. The patient had gross facial asymmetry. This was caused by the malunion of the facial fractures. There was a widening of the canthal bay due to the nasoorbitoethmoidal fracture.

He also had a depressed nose due to a fracture of the nasal bone. CT scans were also obtained for the evaluation of the cribriform plate. Treatment planning was presented to the patient and he consented to surgery.

Facial Asymmetry Correction Performed in our Hospital

A costal cartilage graft was first harvested to augment the depressed nose. The sites of the malunited fractures were then accessed. The plates from the previous surgeries were also removed.

A Titanium mesh with Medpor was then introduced through the subconjunctival incision. This resulted in the reconstruction of the fractured orbital floor. A lateral canthopexy was then performed for the correction of the canthal bay deformity.

This was next followed by augmentation rhinoplasty. The costal cartilage graft was used to raise the bridge of the flat nose. This resulted in the correction of his nasal deformity. An orbital conformer was then placed at the conclusion of the surgery. This resulted in the correction of his facial deformities.

The patient expressed his satisfaction with the results of the surgery. His parents too conveyed their gratitude before final discharge from the hospital.

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What is Maxillary distraction osteogenesis?

Maxillary distraction osteogenesis is a surgical technique that prolongs the lower jaw and forces the tongue forward to widen the airway and corrects these problems. Traditionally, babies with this disorder have been treated by tracheostomy, which continues for many years before the infant develops the condition.

Patient born with the classical presentation of Crouzon syndrome deformities

The patient is a 24-year-old female from Manapparai in Tamil Nadu, India. She was born with the abnormal facial features of Crouzon syndrome. Genetic testing is done soon after birth confirmed the diagnosis.

Crouzon syndrome is caused by a genetic defect that leads to craniostenosis. There is the premature fusion of skull bones in this condition. This leads to the development of deformities of the face and skull.

Manifestation of Crouzon syndrome with bony orbital and midfacial deformities

This patient had most of the classical signs of Crouzon syndrome. She had protuberant eyeballs because of deficiency of the orbital bones. There was also a marked regression of the midfacial region. Strabismus was another classical sign that was seen in this patient along with a beaked nose.

Difficulty childhood due to the extreme degree of facial defects in the patient

She had faced a significant degree of bullying at school. Her parents had therefore decided to homeschool her for a majority of her school years. This limited social contact had resulted in her having very few friends. She had always been socially withdrawn and introverted.

Her parents were counseled by a plastic surgeon that she needed surgical correction of her deformities. They had made extensive enquiries regarding the best hospital to address her needs. A social organization that helps patients with facial deformities had referred them to us.

Premier center for craniofacial deformity correction in India

Our hospital is a renowned center for facial deformity surgery in India. We deal with deformities that are both congenital and acquired in nature. Our center is a specialty center for facial trauma surgery in India. Only a few surgeons in India have the experience required to perform complex craniofacial procedures.

Many patients with congenital facial defects arising from syndromic craniostenosis have been successfully treated in our hospital. Distraction surgery is routinely performed here. Facial bones are brought into perfect alignment through craniofacial surgery.

Initial presentation for of syndromic facial deformity surgery in our hospital

Dr. SM Balaji, syndromic craniofacial deformity surgeon, examined the patient. Imaging studies including 3D CT scans were ordered for the patient. He also obtained a 3D stereolithographic model of the patient’s skull. She had all the classical signs including protruding eyeballs, a beaked nose and midfacial retrusion.

He explained that the patient needed midfacial Le Fort III advancement surgery along with internal distraction. A Kawamoto distractor device would be utilized for this. This was due to the extreme degree of midfacial retrusion. The patient subsequently underwent surgical correction of her deformities.

A bicoronal flap was raised followed by bony cuts to the zygoma. The lower part of the orbital bone was then cut for 180 degrees next. This allowed for dysfunction of the bone. Kawamoto distractors were then fixed and checked with trial distraction.

Her frontal prominence was also reduced through the use of a burr. The bicoronal flaps were closed. Maxillary Distraction osteogenesis commenced after the latency period. A total of 15 mm of distraction was performed. There was a complete correction of her midfacial retrusion along with strabismus. This would normalize her eyesight.

Total patient satisfaction with the results of the surgery

They were ecstatic with the results of the surgery. She could see things clearly now and there was a marked improvement in facial esthetics. Her parents were instructed to bring her back in four months for internal distractor removal surgery. This period would allow for bony consolidation at the site of distraction.

Patient returns for removal of internal distractors after four months

The patient and her parents returned for distractor removal surgery. After obtaining imaging studies, the patient was scheduled for distractor surgery. A bicoronal flap was raised and the distractor was removed by unscrewing the screws. Flap was closed using skin staples.

Her skin staples were removed following the complete healing of the incision wound. They were instructed to return in four month’s time for a checkup. She and her parents expressed their complete satisfaction with the results. They thanked the surgical team before discharge from the hospital.

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