Mohammad Kamal, DMD MD PhD FEBOMFS
Assistant Professor
Oral and Maxillofacial Surgery
Department of Surgical Sciences
Kuwait University
Cleft lip and palate are the most common congenital facial malformation among newborns. In patients with cleft lip and palate, this malformation also leads to a defect in the upper jaw in the region of the lateral incisor and canine tooth. This defect in the upper jaw and the gum region is called an Alveolar Cleft Defect, and it results in abnormal alignment of the upper teeth, missing teeth, and communication between the mouth and the nose. This also leads to abnormal speech, distortion of the nose, and loss of normal lip position; which results in a significant physical disfigurement of the face, and further entails significant psychological distress to both the growing child and the family; thus making these patients more prone to depression, anxiety, dissatisfaction with their facial appearance, social negligence, and increased physical and financial burden on the entire family.
Alveolar Bone Grafting
Alveolar cleft repair is a surgical procedure that is performed to fill the gum defect with bone; in order to stabilize the upper jaw and allow for orthodontic treatment and the eruption of teeth; in addition to sealing any holes between the nose and mouth, and helping in creating an acceptable lip support and shape. The repair of cleft gum defect sites should allow teeth movement into correct position by means of natural eruption, orthodontic therapy, or by insertion of dental implants. Alveolar cleft repair also leads to the improvement of the facial aesthetic appearance, an increasing lip support, improvement in speaking and eating, and overall improvement in the child’s positive self-attributes and psychological well-being.
What is an Alveolar Bone Graft?
An alveolar bone graft is a surgical procedure where bone is placed to fill the gap in the upper jaw region in children born with a cleft lip and a cleft palate. The alveolar bone graft is done several years after the child’s first cleft lip and cleft palate repairs. The timing of the alveolar bone graft is very important because it must be done as the child begins losing his or her baby teeth, before the permanent teeth emerge, which is usually around 8 to 11 years of age.
How is the Alveolar Bone Grafting done?
A piece of bone is usually taken from the upper part of the hip bone. The type of bone used is soft and can be easily shaped to form the patch that will close the hole in the alveolar bone. The gum will then be closed around the new graft and held in place with sutures while it heals.
Why Does My Child Need an Alveolar Bone Graft surgery?
Having a gap in the alveolus means that the adult teeth may not be able to grow into the mouth properly in the correct position. There may also be a gap between the mouth and the nose where air or liquids can pass through, which results in food or drink coming down the nose.
The bone grafting procedure aims to fix these problems, and to:
- Prepare the alveolus for the adult teeth to grow (and for these teeth to be able to be straightened later with braces if necessary)
- Stop food and drink coming down the nose
- Try to help the bottom of the nose look a little straighter.
When is Alveolar Bone Grafting Done?
The timing of the operation depends on the growth of the adult teeth. It usually happens between the ages of 8 and 11 years. The best time will be decided by the surgeon (who performs the operation) and the Orthodontist (a specialized dental surgeon who straightens teeth using dental braces).
What to Expect After Your Child’s Surgery?
Your child’s alveolar bone graft surgery will be done under general anesthesia, which means that he or she will be sound asleep during the surgery and will have no memory of it. This surgery usually takes about 1-2 hours, depending on the type and size of graft your child needs. Your child will stay overnight in the hospital for at least 1-2 days after the surgery.
What Can My Child Eat After the Surgery?
- Initially, your child will have a fluid infusion via a drip. The infusion will be reduced as your child is able to drink and eat orally.
- Immediately after the surgery, your child may not be allowed to eat or drink for at least 4-6 hours, to allow time for the wound to start healing and reduce risk of bleeding.
- Your child will then slowly be allowed to start drinking clear fluids (water, cordial, apple juice, icy poles and jelly) and then may start eating soft food.
- Children need a variety of food each day to provide them with the nutrition they need to grow and develop. Following the surgery, your child will not be allowed to eat certain food. This is to make sure that the surgical site is not damaged in any way. Your child may also have a sore throat.
- It is important to consider the types of food and drinks that you offer your child until they are back on their usual diet; so they do not miss out on any vitamins or minerals.
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