Balaji Dental & Craniofacial Hospital

Balaji Dental ISO 9001:2008
Dr SM BALAJI

Tumor | Facial Reconstruction Surgery


A tumour is an abnormal mass of tissue resulting from uncontrolled and uncoordinated growth of normal cells. Jaw tumours that arise from tooth forming tissues are called odontogenic tumors. The jaw tumours that arise from tissues other than tooth forming tissues are referred to as non odontogenic and they may occur in regions other than the jaw bone. Tumours are classified as malignant or benign according to their biologic nature.

Renowned Facio-Maxillary Surgeon Dr. S.M. Balaji is highly proficient at jaw tumor removal and complete facial reconstruction. He has successfully rehabilitated innumerable patients afflicted with jaw tumor. He has introduced several surgical innovations which have immensely benefitted the patients, including biotechnologically advanced protein rhBMP-2 which stimulates new bone formation when placed in bone deficient regions and Transport Distraction Osteogenesis which stretches and expands bone and overlying soft tissues. These are some techniques used here routinely for complete facial reconstructive surgeries.

Jaw tumour resected and total jaw reconstructed for a one year old child for the first time


Rare Facial Disorder
For the first time in the world, a rare type of facial and jaw bone disorder was rehabilitated completely for a one year Maldivian Child. The child was suffering from a rare form of osteodystrophy. In the disorder, the bones are gradually replaced by the fibrous tissues. This disorderly bone formation would result in the complete destruction of the involved bone. When jaw and facial bones are affected as in the case of this one year old boy, it leads to disfigurement in addition to speech difficulties, feeding problems and most importantly the psychological development.

Child at 7 months of age with no evidence of disease   Child at 18 months of age with tumour in upper and lower jaw  
Child at 7 months of age with no evidence of disease   Child at 18 months of age with tumour in upper and lower jaw  

Treatment options
The treatment option for osteodytrophy is surgery that is usually done when most of the growth of child ceases, that is by 15 years. For this child, beside the other problems, he will have impeded facial growth, if not correctly treated. The boy suffered this disorder in the upper and lower jaw. Distorted jaws will impede the growth of the other facial bones too. Entire upper jaw and almost the entire lower jaw except the joint were involved with disease. Hence an urgent facial surgery was the only option with a careful post-operative monitoring. Many centers across the globe and India, did not readily take up the child owing to issues with age, disease severity and multiple problems with reconstruction. Rehabilitation is tough as the patient is a young child where microvascular surgery is tough owing to smaller size of the blood vessels. Use of revolutionary cutting edge technology – bone morphogenetic protein-2 (rh BMP-2) was employed for this child. This involves recruiting the stem cells to synthesize required new bone.

Balaji Dental and Craniofacial Hospital, Chennai
Parents were referred to Balaji Dental and Craniofacial Hospital, Chennai for expert advice and management. The renowned and internationally acclaimed craniofacial surgeon, Dr. S.M. Balaji readily took up the challenge to help out the child and his parents in distress. After advanced investigations and meticulous planning, the surgery was executed. The surgical team under Prof. Dr. S.M. Balaji performed this exceptional surgery for the first time,that extended beyond 6 hours. The titanium plate used for the surgery was customized by Dr. S.M. Balaji himself and was procured from the U.S. The bone for reconstruction was harvested from a rib of the child that would eventually grow back to its normal size.
CT scan image showing tumour in upper and lower jaw  
CT scan image showing tumour in upper and lower jaw  

Surgery
The highlight of this surgery was that the entire surgery was performed through the mouth itself. This eliminated the incidence of scars on the child’s face. This was for the first time a 1 year old child from a foreign country was operated for such a disorder in India. The lengthy surgery involved removal of the diseased portion of the jaw, reconstruction with a customized, imported, titanium plate and the child’s own rib graft. To promote and balance bone union, bone morphogenetic protein-2 (BMP) was employed. This protein would attract the pluripotential cells to synthesize the bone. The child responded well to the treatment and returned to his homeland with happy and contented parents.
Removal of the tumour from the upper jaw   Removal of the tumour from the  lower jaw   Jaw reconstruction using bone graft and rhBMP-2  
Removal of the tumour from the upper jaw   Removal of the tumour from the lower jaw   Jaw reconstruction using bone graft and rhBMP-2  

Follow-up
After six months, a follow up CT scan was done. The CT scan revealed a good amount of normal bone formation in the jaws. Entire lower jaw has grown uniformly and active bone formation is proceeding to the expected level. In the event of not using BMP, the graft would have been resorbed. If the plate is only used, no bone would have been formed.
Postoperative CT scan image   The child a few months after jaw tumor removal  
Postoperative CT scan image   The child a few months after jaw tumor removal  

Dental rehabilitation with Implants
Since tumor affected portions of the jaws were removed, the boy will not have his natural teeth in those regions of the jaws. To facilitate normal chewing, eating and speech development and for overall good health of the boy, dental implants were placed in his jaw bones. After osseointegration of the implants with the surrounding new jaw bone, ceramic (porcelain) crowns resembling natural teeth will be fixed onto the implants.
The child with Dr. S.M. Balaji before dental implant surgery X-ray before implant surgery, showing good healing and recovery Lower jaw before placement of implants
The child with Dr. S.M. Balaji before dental implant surgery X-ray before implant surgery, showing good healing and recovery Lower jaw before placement of implants
Implants being placed in the lower jaw   Implants being placed in the lower jaw   Implants placed in the upper jaw  
Implants being placed in the lower jaw   Implants being placed in the lower jaw   Implants placed in the upper jaw  
X-ray after dental implant placement   The child with Dr. S.M. Balaji after dental implant surgery      
X-ray after dental implant placement   The child with Dr. S.M. Balaji after dental implant surgery