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Secondary Bone Graft

Surgical Details

Where is the bone taken from?

  • A small section of hip bone is used.  An incision is made and bone is removed from the inner surface of the hip.  This is about 1x1 in or 2.5x2.5cm bone.  Additionally the soft inner bone (marrow) is also used.

  • Artificial bone doesn’t work because it doesn’t grow and develop with the child like real bone.  Bone taken from other people usually is rejected or disappears.

  • Other bone generating substances (BMP) have been used, but these have not provided a consistent result or sufficient volume.

How is the bone graft placed?

  • All the surgery is done inside the mouth on the gum tissue and behind the upper lip.  The lip repair is not taken apart. 

  • Cuts are made along the edges of the gum and in the pink lining tissue, the gingiva and mucosa. 

  • The bone edges are exposed and a small pocket is made on either side of the cleft. 

  • The bone graft is placed to reconstruct the floor of the nose and the roof of the mouth.

  • Bone is filled between the gap

  • The lining tissue of the palate and the gum is repaired.

  • It is important to remove baby or permanent teeth that will not be used at least 6 weeks before the surgery. As these will leave 'holes' in the gum lining and will need 3-4 weeks of healing time.

  • The quality of this lining tissue is imporatant as it covers the bone graft and provides the bllod supply needed for the bone to live.

  • In double clefts the gingival mucosal tissue is of poor quality and has a poor blood supply. Sometimes this needs to be staged as to separate opeartions or a repeat operation.

  • This a very simple explanation of one way of how it can be done. How it is exactly done for each child will depend on the severity of the deformity. 

Risks, Complications and Outcome?

  • Risks of general anesthesia (discussed by anesthesiologist) 

  • Infection and bleeding

  • Temporary or pernanent loss of a sensory nerve in the region of the thigh from the bone graft.

  • Outcome: Most bone grafts are successful. They accomplish the major goal of the surgery which is to the dental development and nasal support. But there is a percentage of children who may need additional bone later in childhood to replace a missing tooth that will need an implant. This is because the thickness (volume) may not be enough to support the implant. The need for an additional bone graft can only be determined 8-12 months after surgery with an x-ray. It is rare for a bone graft to completely fail, if this occurs it is usually due to poor blood supply, infection or some unusual circumstance. 

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