Facial trauma or maxillofacial injuries includes injuries to the facial skin or bones, jaws, nose, sinuses, teeth or other parts of the mouth. The most common causes of facial trauma are motor vehicle accidents, sports mishaps, accident at home or acts of violence.
Face injuries can be complex. Facial disfigurements may cause acute and long-term psychological problems. Treating facial injuries require specialized skill, precision and extensive experience. Immediate first aid is required to rule out potentially life threatening conditions. Following this, a comprehensive reconstruction of the face is required depending upon the age of the patient, severity of the injury and other crucial factors like concomitant medical conditions.
Facio-Maxillary Surgeon Dr. S.M. Balaji is renowned for his expertise in treatment of face and jaw bone fractures and facial soft tissue injuries. Our Hospital is equipped with the latest diagnostic tools including 3D Cone Beam CT scans (CBCT), CT scans and specialized Digital X-rays to help aid in complete rehabilitation of those inflicted with facial injuries.
4-year-old Choreen Vidoet from Seychelles was a bubbly toddler when one day she met with an unfortunate mishap. Accidentally she suffered a severe electric burn injury to the left side of her mouth, nose and face. After immediate first aid treatment in Seychelles, she was referred to craniofacial surgeon Dr. S.M. Balaji for specialized facial reconstruction.
Electrical burns to the mouth due to household appliances are frequently seen in children. The saliva which is rich in electrolytes acts as a good conductor of electricity. It allows arcing and concentration of the burn.
Choreen had severely burnt mouth, nose and left cheek causing a facial disfigurement in the left half of her face. It is important that the child eats and drinks as normal. Effective management is essential to prevent loss of function & cosmetic disfigurement and reduce the psychological trauma that can be associated with any severe burn. Reflecting the potential gravity of facial injury, Dr. Balaji devised an advanced surgical treatment plan. Wound debridement was done. Dead skin and tissue were removed.
Skin graft and transplant are often used to produce cosmetic result. This is usually obtained from inner thighs of the patient that will result in scar formation. Moreover the graft will be of different color shade, texture and thickness. Considering the young age of this girl child, Dr. Balaji used the latest innovation called “Tissue expanders”.
Tissue expansion is a surgical procedure to grow extra skin through controlled mechanical overstretches. It creates skin locally that matches the color, texture and thickness of the surrounding tissue, while minimizing scars and avoiding secondary surgery for graft in sensitive inner thigh.
The child suffered severe burns of the left side of her face; the child after reconstructive surgery
Tissue expander device used to stretch healthy skin and grow tissue locally
Tissue expander device being infused with saline
Inflating the device stretches the skin and new tissue is grown
The newly grown excess tissue is mobilized to reconstruct the burnt portions of the face
Nose reconstructed with forehead rotation flap
After successful reconstruction, Choreen with Dr. S.M. Balaji and her parents
For Choreen, an inflatable balloon-like device called tissue expander was implanted beneath normal healthy skin of the cheek. Over the next few weeks, 15 ml of saline was injected into the expander per week. This inflated the balloon exerting a constant mechanical pressure and stretching the overlying healthy skin and tissue. Cell growth led to formation of new cells. After due interval, the tissue expander was removed. The excess skin grown locally was used to successfully reconstruct the burn wounds of the mouth and cheek.
The child’s nose was reconstructed with a surgical flap from the forehead. A graft with section of the skin and blood vessels was taken from the forehead, rotated and the nose was reconstructed with the base of the graft still attached to the forehead. After a few days, blood supply was established and the graft was cut off from the forehead. With this reconstruction, there is no color mismatch and it improves the appearance of the nose.
Baby Chorren has a virtually a new face reconstructed and sculpted by Dr. S. M. Balaji. Tissue expansion technique has been used for the first time for an extensive facial reconstruction in an Indian craniofacial unit. Since the skin used was from the child’s cheek, there was no color mismatch and the wound healed well while completely avoiding an additional skin grafting surgery and scarring on the child’s thigh. The parents are happy to see their child defect free and thank Dr. Balaji.