A Rare Case Handled Well

Spigelian Hernia Surgery

Dr. Lokesh Kumar

Dr. Lokesh Kumar
Director & HOD
BLK Centre for Plastic
& Cosmetic Surgery
BLK Super Speciality Hospital
New Delhi


Facial Rehabilitation in Facial Deformity

Patients with syndromes like Crouzon that lead to severe facial / cranial deformities have to face a lot of psychological issues. Craniofacial surgery is one such surgical measure that may come to their rescue. This surgery that can transform the lives of patients from such Craniofacial anomalies is available only in a few centres in India. Recently, BLK completely transformed the life of a young girl using complex Craniofacial surgery methods like LeFort III and LeFort I Osteotomy.

LeFort III (LF III) Osteotomy by virtue of its level and anatomical outline allows the surgeon to modify significant facial landmarks. A Crouzon Syndrome patient commonly reveals severe exorbitism or bulging of eyes. The mid-face appears short vertically and severely retruded, causing a severely concave profile.

Lefort III Osteotomy is a Craniofacial Disjunction procedure which requires mobilization of whole of the midface. The Osteotomy starts at the frontozygomatic (FZ) suture. The Osteotomy line is carried from the FZ suture medially along the lateral wall, then to the floor and continuing up to the medial orbital wall and the nasal bones. Zygomatic arches are divided in the middle.

Craniofacial Disjunction is then performed just below the frontonasal suture, keeping in mind the cranial base slope. Next, Pterygomaxillary Disjunction is carried out and whole of the midface is mobilised. Following completion of the LF III Osteotomy, LFI Osteotomy is carried out. A surgical splint is then used to bring the dentition in the desired occlusion. The planned advancement at the upper midface level is accomplished. The bone graft is used to bridge the Osteotomy sites. Orthodontic treatment is started at around 3 weeks post-surgery to bring the teeth into proper bite or occlusion.