Cleft Alveolar (upper jaw) Bone Grafting

A cleft alveolus is a congenital bony defect of the upper jaw which is usually associated with a cleft lip and palate. This defect, if not repaired can lead to problems with the growth and development of both the teeth and the jaw. Therefore, it is recommended that a bone graft be placed in this area. Surgery to bone graft the cleft area usually occurs between the ages of 5 to 13 years, dependent on each individual case.

 Reconstruction of this cleft alveolus allows and provides for:

 Upper jaw continuity for tooth eruption and orthodontic (braces) correction of malocclusions (bad bites).

1. Bone support for adjacent teeth
2. Bone support for the nose
3. Restoration of upper jaw form.
4. Closure of holes from mouth to nose.
5. Improved cosmetic appearance of lip and nose in some cases.
6. Improved speech in some cases.
7. Stabilization of the premaxilla in bilateral clefts.
8. The elimination of the need for prosthetic tooth replacement (dentures & bridges) in some cases.
9. A limited period of disability.

 It is customary to harvest the bone from the hip (iliac crest) and transplant this bone into the prepared cleft alveolus. There is reconstruction of the nasal floor and oral soft tissue. This allows for the creation of a pocket where the bone is placed. The holes (fistulas) are closed with the tissue and bone.

 This is an in-hospital operation that takes approximately 2 to 4 hours long and requires a 2 to 3 day hospital stay. The hip is very sore for the first 2 to 4 weeks and recovers to normal function afterwards. You can also expect some swelling and tenderness both in the hip and mouth surgical sites. All stitches dissolve unless otherwise stated by the surgeon.

 It is important that after the surgery a stringent protocol be followed:

1. No blowing your nose or sucking on straws for 6 weeks.
2. Blenderized or liquid diet for 3 weeks. No chewing with the front teeth for 3 weeks.
3. No nasal sprays for 6 weeks.
4. You must keep the teeth clean (brushing). Stay away from the gums for 4 weeks.
5. Take your antibiotics until they are finished.
6. Rinse with your antibiotic solution 3 times a day.
7. Rinse all suture sites including the roof of the mouth with either salt water or the antibiotic solution.

 It is important to follow these instructions as it gives us the best opportunity for success. Surgical complications seldom occur, but you must be aware of the possibility. Possible complications include and are not limited to the following:

• Loss of the bone graft.
• Infection.
• Numbness
• Loss of teeth, tissue or bone.
• Haematoma.
• Creation of a larger hole.
• Breakdown of the surgical site and possible need for further surgery.

This is only a brief overview to assist you. Your doctor will discuss the details of each individual case with you. In addition, if there are any questions for concerns, please don’t hesitate to contact your Oral and Maxillofacial Surgeon .

I recommend reading the following informative soft covered book “The cleft palate story” by Samuel Berkowitz (ISBN 0-86715-259-1) available through most bookstores. It is designed specifically for the parents and is easy to read.