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Patient with failed surgery elsewhere presents for correction
The patient is a young woman with failed condylar hyperplasia surgery performed elsewhere. She presented to our hospital for correctional surgery. Dr SM Balaji examined the patient and ordered detailed studies for the patient.
Rib graft and buccal fat pad graft obtained from the patient
Under general anesthesia, a rib graft was first harvested from the patient. Valsalva maneuver demonstrated a patent thoracic cavity. The incision was then closed with sutures. This was next followed by harvesting of a buccal fat pad graft from the right cheek.
Augmentation of the mandibular body done with grafts
A left sided maxillary vestibular incision was next made. The bone grafts were then shaped and fixed with screws in this region. Attention was next turned to the mandible. A mucogingivoperiosteal flap was then raised. The bone grafts were then screwed in place in the molar region. This led to adequate augmentation of the body of the mandible.
Maxillary repositioning and buccal fat pad transfer performed
Attention was next turned to the anterior maxillary region. An osteotomy was then performed and the maxilla repositioned with four holed plates. This was then followed by transfer of the buccal fat pad graft to the left cheek. All incisions were then closed with sutures.
The patient expressed complete satisfaction with the results of the surgery before discharge.
Young boy with dentigerous cyst presents with nonvital teeth
The patient is a young boy who presented with a swelling in the left anterior maxilla. Dr SM Balaji examined the patient. The teeth in the area of the swelling were nonvital. Radiograph revealed the presence of a large dentigerous cyst in that region. Treatment planning was for surgical excision of the cyst.
Dentigerous cyst enucleated and teeth saved
A mucogingivoperiosteal flap was first raised in the anterior maxillary region. There was a supernumerary tooth present within the dentigerous cyst. The dentigerous cyst was then enucleated and removed with care taken to save all RCT teeth. A rib graft was then harvested to fill in the bony defect. Valsalva maneuver demonstrated lack of perforation into the thoracic cavity.
Bony defect filled with harvested rib graft
The harvested rib graft was then cut and shaped to fit into the bony defect. The graft was then fixed with screws. The flap was then sutured back in place. Postoperative healing was uneventful.
Patient with prognathic maxilla and short upper lip presents for surgery
This young man presented with a vertical excess of the prognathic maxilla. It resulted in the shortening of the upper lip with inability to appose the lips. This was causing social problems for the patient. He presented to our hospital for surgical correction of his problem.
Treatment planning explained to the patient
Dr SM Balaji examined the patient and ordered imaging studies. On cephalometric analysis, it was found that he had 7 mm vertical excess of maxillary bone. He explained the treatment plan to the patient who agreed to it.
Successful Le Fort I surgery with optimal results for the patient
Under general anesthesia, a Le Fort I maxillary osteotomy was performed initially. The maxilla was then disengaged from the facial bone. A 7 mm strip of maxillary bone was removed in the horizontal plane. The disengaged maxilla was then repositioned superiorly with two X-plates and screws. Occlusion was then checked and found to be perfect. The incision was then closed with sutures.
The patient expressed his complete satisfaction at the results of the surgery.
Neurofibroma explained to be an inherited disorder
Neurofibroma is a benign tumor of the nerve sheath. It arises from the peripheral nervous system. An inherited disorder, is very disfiguring and adds bulk to the affected tissues. It always results in asymmetry of the affected region.
Young man with neurofibroma presents for surgery
This is a young man from Thalassery. He has had this debilitating condition since childhood. His face is only affected on the right side. The right eye had also become blinded by this condition. He has undergone previous surgery elsewhere in the past for the tissue overgrowth. He has become reclusive and withdrawn because of this. The growth has recurred again to the point it interfere with his activities of daily living. His family conducted extensive enquiries with medical professionals for the best cosmetic surgeon. These enquiries led them straight to our hospital for management of his disfigurement. He will need another surgery to correct his lower lip disfigurement.
The patient examined and treatment plan explained
Dr SM Balaji examined the patient and explained the treatment plan. The patient was in agreement with this.
Surgery is done with removal of overgrowth of excess fibrous tissue
Under general anesthesia, excess neurofibromatous tissue was first retracted and then excised. The proliferation of this tissue in the lobule of his right external ear was also trimmed. This resulted in the improvement of the patient’s facial contour. After removal of adequate tissue, the incisions were then closed with sutures.
The patient expressed satisfaction in the improvement of quality of life before discharge.
The patient is a young man who presented to our hospital for facial feminization surgery. He had zeroed in on our hospital after extensive Internet research. Dr SM Balaji is a member of the W-PATH. This organization dedicates all its efforts toward improving transgender healthcare. It aims to provide accessible healthcare for persons with different gender identities. The patient had a hypertrophic masseter.
Diagnostic studies performed for treatment planning
A 3D axial CT was first obtained for treatment planning. This planning proceeded after obtaining his biometrics. The patient agreed to the treatment plan and was then scheduled for surgery.
Facial feminization surgery with good esthetic results
Under general anesthesia, a right mandibular vestibular incision was first made. The bone at the gonial angle was then reduced to reduce its prominence. Excess masseter muscle was then excised and removed. The same procedure was then performed on the left side with symmetrical results.
Bimaxillary setback surgery was then performed through an osteotomy of the maxillary bone. Advancement genioplasty was next performed. Osteotomy was then performed with good cosmetic results. Occlusion was perfect at the end of the two procedures. All incisions were then sutured close.
The patient expressed his satisfaction at the results before final discharge.
Patient with prognathic mandible presents for surgery
This young man always had a very prominent mandible. He had always hated it and wanted it corrected. This had also been a source of difficulty with eating due to malocclusion. He decided to get this treated and turned to the Internet. He researched the Internet for the best jaw correction surgeon. His search led him directly to our hospital.
Treatment planning explained to the patient
Dr SM Balaji examined the patient and ordered diagnostic studies. He explained his treatment plan to the patient. The surgical plan was to perform an Obwegeser’s bilateral sagittal split osteotomy. This would set back the lower jaw.
Complete correction achieved with surgery with no scarring
Under general anesthesia, incisions were first placed in the retromolar area. The bone in this area was then exposed. Osteotomy cuts were next placed taking care to protect the inferior alveolar nerve. The position of the teeth and the amount of setback required was also kept in mind. Bilateral sagittal split osteotomy was then performed.
Excess bone was then removed and correct occlusion achieved. The bony segments were then stabilized using titanium plates. Incisions were then closed with sutures. This procedure was done on both sides. The entire procedure was intraoral with no residual scarring.
The patient expressed his satisfaction at the results of the surgery before discharge.
