Balaji Dental & Craniofacial Hospital

Balaji Dental ISO 9001:2008
Dr SM Balaji with the Minister of health

Birth Defects | Facial Reconstruction Surgery


Birth deformities of the head and face not only affect vital functions like eating, swallowing, speech and breathing but also affect facial appearance, face symmetry and psychological well being of the patient.
Facial reconstruction surgery is performed to restore normal facial structure and function. These may comprise of intricate procedure involving not just face skin and bones but also nerves, muscles, and major blood vessels of the face.

Dr. S.M. Balaji is a skilled specialist in facial reconstructive surgeries. He has successfully employed several advanced procedures, often a combination of more than one technique, to completely reconstruct the face of several persons with facial disfigurements. He is internationally acclaimed for his prowess in reconstructing facial features providing a wide range of treatment options for both children and adults with severe facial defects.

Facial reconstruction surgery successfully done for Sri Lankan boy with Tessier’s cleft

Ansif Ahmed, was born with an extremely rare condition called Tessier cleft. These are severe deformities in which there is a gap in the soft tissues and bones of the face. Clefts are caused when parts of the face fail to join properly when the baby develops in the womb.

One-year-old Ansif’s facial cleft defect was complex. It involved his upper jaw, nose, forehead & both his eyes. There was a huge gap in his upper lip and roof of the mouth causing a communication between his nose and mouth. He had great difficulty in breathing, feeding, eating and speech. Food would pass from his mouth into the nose causing him to choke and not eat properly. The distressed parents approached many doctors but were turned down due to the complexity of the problem at such a young age.

Tessier cleft deformity, before surgery   reconstructing the roof of the mouth and upper lip, enabling the child to breathe and eat normally  
Tessier cleft deformity-before surgery   During Surgery  
During surgery, reconstructing the roof of the mouth and upper lip, enabling the child to breathe and eat normally   After cleft lip and palate surgery  

reconstructing the roof of the mouth and upper lip, enabling the child to breathe and eat normally

  The child a few months after jaw tumor removal  
They then sought the expertise of eminent Facio-Maxillary surgeon Dr. S.M. Balaji, at Balaji Dental & Craniofacial Hospital, Chennai, India. Due to the complexity of the problem, Dr. Balaji performed an advanced surgical procedure combining two treatments and repairing both the cleft lip and cleft palate in a single surgery. Bone defects in the upper jaw are usually treated with bone grafts taken from the rib or hip region. It however involves an additional surgery and scarring at the graft site. This can be avoided by using a new invent rhBMP-2, a biotechnologically manufactured version of a natural protein. When placed in the bone-deficient area, it stimulates the body’s own stem cells to form new bone ultimately healing the bone defect. Dr. Balaji is credited with successfully applying this pioneering technology with excellent results.

After this surgery, Ansif is able to eat and swallow normally. His breathing has become easier and the repair will help develop his normal speech. There is also a drastic improvement in his appearance.

Balaji Dental & Craniofacial Hospital is a leading multi-speciality dental, cosmetic and craniofacial surgical hospital and a centre of excellence in the rehabilitation of cleft lip & palate and facial disfigurements.



Creating the Face with Recombinant Technology Iraqi Child gets a new face at Chennai

The child with massive facial defect

When Mohammad Othman was born in Iraq, the parents could not rejoice because half the face of the baby was missing and was replaced with a huge hole that was probably the mouth of the baby. The other eye and the nose of the baby were normal and the child was otherwise healthy. CT scan of the child showed that one half of the child’s skull was totally missing and not formed at all. Due to this, the lips, cheeks, eye sockets were not formed. The baby’s breathing and feeding were a challenge to be surmounted which the local doctors struggled with and the baby thrived.

Referred to Dr. Balaji

Due to the magnitude of the defect, Dr. Ramzi Mansour, Director of Health, MOH, Government of Iraq referred the child to Prof. Dr. S.M. Balaji, who is known for his success in complex facial reconstructions. The baby was brought to Balaji Dental and Craniofacial Hospital, Chennai, India for the restoration of his un-created face. On examination, Dr. Balaji found that the child had a rare combination of craniofacial cleft deformity classified as Tessier 3,4,5,6 and 7 with the total absence of bones of the upper jaw, lower jaw, eye socket, part of the forehead and nasal bones on the left side of the face. However his brain was normal. The eye was formed but due to the absence of the socket, it was buried deep inside the skin and he had vision in his right eye only. The ears, upper lip and cheek were totally absent. Dr. Balaji assessed his defect and found that it was an absence of bone that is innervated by the trigeminal nerve and therefore was due to the deficiency of structures formed from rhombomeres r2 and r3. This had caused a loss in chemical concentration of BMP while the face of child was being formed, resulting in lack of bone formation and subsequently the soft tissues; leaving the child with an unformed left face.
before treatment child with facial clefts   CT SCAN showing birth defect  Left eye raised and fixed with titanium plate in odified Y -plate canthopexy method    
Before treatment child with facial clefts   CT SCAN showing birth defect Left eye raised and fixed with titanium plate in odified Y -plate canthopexy method
 Immediate post operative   After Treatment Dr SM Balaji    
Immediate post operative   After Treatment Follow up visit with parent    
           
First Stage Surgery

Dr. Balaji set about the task of first creating a lip for the child to enjoy eating and to preserve the nature of the tissues of the nose and mouth which were now getting dry and skin-like due to constant exposure to the atmosphere. The child was also unable to accommodate his tongue properly and was placing it within the defect, making the cleft defect wider. The lip is a unique structure of muscle and skin that needs to be created from the adjoining tissue otherwise a skin colour mismatch may occur. Skin and lip tissue from the lower lip was mobilized to create the upper lip, cheek and nose. The modiolus of the lip was created by rotating the tissues 180o. The gaping hole in his face was closed and the child was able to breathe normally and eat by himself without help.

Second Stage Surgery

The second stage of surgery was taken up wherein the growing potential of the child's remaining jaw bones were assessed. Due to the lack of bones on the left half of his face, growth was limited. Dr. Balaji operated on him to provide growth center transplantation from his rib to create the missing lower jaw. Before creating the upper jaw, he had to find a stable way of rotating the eye and the eye brows to a normal level since the left side of the face was lower than the normal right. He used his own original technique, called the modified Y-plate canthopexy, to pull the eye up by suspending the medial canthus to a titanium plate fixed to the forehead and bring it out of its buried state. The upper jaw creation was initiated using stem cells and growth factors after securing the eye in place using rib grafts. In order to reverse the damage produced by the lack of BMP-4 concentration, recombinant BMP-2 was used to stimulate the bone forming cells to create new jaw bones. Tissues from the neck were moved to cover the newly created cheek, jaws and eye.

Presently

Now Othman is on a road to recovery with the missing facial bones created from the stem cells and grafts. Dr. Balaji is confident that he will be able to re-create his ear soon after the upper and lower jaws mature fully. Now Othman has a near-normal appearance and is happy to go to his nursery school in Iraq without any hindrance. He eats, talks and breathes normally. Othman’s parents are satisfied with the results and are looking forward to sharing his happy childhood.