P K Patel MD
Primary Bone Graft
Infancy to Early Childhood
1. Before the Surgery
Our office coordinates scheduling of surgery typically Wednesday. Please make sure we have a good contact number for us to reach you.
This procedure is covered by insurance providers and we have never had difficulty in obtaining approval.
Even though we assign a surgery date, there is a small possibility of a last minute change because of the urgency of other cases (cancer, transplant, trauma). We appreciate your understanding and apologize for the inconvenience.
Please have at home before the surgery:
Infants / Child Acetaminophen (Tylenol)
Infants / Child Ibuprofen (Motrin/Advil)
Please make an appointment with your pediatrician 2-3 weeks before the surgery. Please have their office complete the history/physical form needed by our anesthesiologists. Please fax this to our office and bring a copy with you at the time of surgery. The form is provided by our office. If you do not have a copy of it, please contact us.
The Hospital will contact you and give you the time of surgery and when to stop feeding your child.
Please arrive 60 minutes before the scheduled time of surgery. It is better to be early than late. The surgery may be rescheduled depending on the other surgical cases.
If your child is developing a cold or has had a cold within 2 weeks of surgery date, the surgery will need to be re-scheduled. Please contact our nurse as soon as possible.
2. About the Surgery
The surgery is done under general anesthesia
Bone graft: Borrow a small segment of rib (3/4in / 2cm)
It takes approximately 2-3 hours
I will call you and see you as soon as the surgery is done
You will see your child in the recovery room
It will take an additional 2-3 hours before yo can go home
Surgery is considered out-patient surgery (only in rare circumstances does the child need to stay overnight)
3. After the Surgery
Controlling Pain and Discomfort
Use Acetaminophen (Tylenol) or Ibuprofen (Motrin / Advil) for the
Follow the directions on the label based on the child's weight/age
Pain control is mainly needed for the first 2-3 days after surgery
Alternate the Acetominophen with the Ibuprofen
Follow the directions on the antibiotics. If you miss a dose do not double it. If your child develops diarrhea, please discontinue the antibiotics.
What to eat
Begin slowly after the surgery to minimize nausea
Encourage as much liquids after surgery as much as possible to avoid dehydration (Infants and Children can easily bcome dehydrated)
Eating will come as the pain/discomfort gets better after surgery
Wash and bathe your child normally the day after surgery
There are no restrictions in actvities or positioning in sleeping
Operative Site Care
The tape over the site where the rib graft was taken will come off on its own within 10-14 days.
The mouth can be cleansed as before the surgery. The stitches will 'fray' out on its own.
Wipe the gums off after each feeding with a warm, wet washcloth or a dampened piece of gauze wrapped around your finger.
Follow Up Appointment
Contact our office at 312-996-7546 and make an appointment 2-4 weeks after surgery. Please call sooner if you are concerned.
4. The Outcome of Surgery
A few weeks to months after surgery sometimes the bone graft can become exposed. This is because of the active dental development that occurs. The teeth may push through the graft, behind the graft or in front of the graft.
Sometimes a hole develops in the area with the teeth are psuhing through. Fluid may communicate between the mouth and the nose. This is something we can not control and in time will be repaired later in childhood.
Occasioanally a small chip of the bone graft may fall out as the teeth are pushing through. This is OK. Continue to care for the site as above.
Clean the area with a Q-tip soaked in warm salt water. This will help the mucosa to heal over it.
Make an appointment to come see us when this happens. It is not urgent.
The grafts primary purpose at this age is to stabilize the cleft by bridging the two segments of the upper jaw.
But whether there is enough bone to support the eventual dental development or support of the nasal base, we will not know until later in childhhod.
At age 6-8 we can better determine whether additional bone is needed. At this age we can obtain a good x-ray and see all the developing teeth in the region. This is done at the time of the orthodontic consult.