Primary Bone Graft

Surgical Details

A small section of rib (about 1inch) is used. The bone is taken from the chest wall in such a way so that there is a high likelihood of the rib to regenerate. Though it may not regenerate as a normal rib, there is no significant downside. The scar on the chest wall will be about 2 inches long.
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.

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 called mucosa behind the upper lip.
The bone edges are exposed and a small pocket is made on either side of the cleft.
The rib is then split lengthwise and is placed as a strut across the defect in the gum into the pockets. The other half of the rib is minced and mixed with the marrow. This is then packed into the cleft site behind strut.
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. Sometimes another strut is placed behind the gum line in addition to the one in front of the gum line.

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Risks of general anesthesia (discussed by anesthesiologist)
Infection and bleeding
Chest wall pleural cavity tear at the time of the rib harvest. Repaired at time of surgery. This would require an overnight admission. In over 20 years of surgery, this has not occured, but is it always possible.
Outcome: Most bone grafts are successful. They accomplish the major goal of the surgery which is to bridge the defect in the gum and to stabilize the two segments. But there is a percentage of children who may need additional bone later in childhood for the permanent teeth or to replace a missing tooth that will need an implant. This is because the thickness (volume) may not be enough to support the teeth. The need for an additional bone graft can only be determined in late child hood (ages 6 to 12) when the permanent teeth are coming in and the orthodontist is beginning to align the teeth. It is rare for a bone graft to completely fail, if this occurs it is usually due to infection or some unusual circumstance.