What happens during surgery and recovery?
An ABG is performed when your child is approximately 9-11 years old. The purpose of the bone graft is to fill the gap in the gum line so that the upper arch is stable, and there is somewhere for the canine tooth to erupt. If there is no bone in this area, that tooth will be lost, and there won’t be a secure way for the orthodontist to move the teeth with braces. The ideal time for the bone graft is when the canine is starting to descend into the cleft, so it is the orthodontist that lets us know when your child is ready for surgery.
During surgery, we lift the tissue of the gums off of the bone and teeth in the area of the cleft, the front part of the palate, and the floor of the nose. If there is any remaining connection or “fistula” between the nose and mouth, we close it. Then we create a water-tight pocket for the bone to be inserted. We take the bone from the front of the hip through a very small incision that can be hidden in the underwear or swimsuit line. We open the hip bone and take out a small amount of bone from the marrow cavity with the help of a special drill. The outer part of the hip bone is closed, and the incision is closed with dissolving sutures and covered with skin glue. The bone is then placed into the pocket, and the gum tissue is sewn over the top with dissolvable sutures that will fall out in several weeks. If your child needs a repeat bone graft, we will often use a bone substitute and substance called BMP. This stimulates bone growth, helps improve the success rate, and saves your child from another bone harvest.
Expect that you will spend 1-2 nights in the hospital. You will be able to go home once your child is eating, pain is controlled, and they are able to walk. In general, the surgery is not particularly painful, but your child’s hip will be sore for several days to a week. Expect that there will be some swelling of the upper lip and face and some bloody drainage from the mouth and nose. You will have to be very careful not to brush the upper gum/teeth till the area is healed. Because of this, we ask you to have your child use a special mouthwash at least three times a day and after all meals. In order for the bone graft to heal, it is very important that the bones around the cleft do not move at all. This means that your child cannot bite anything with the front teeth. For the first two weeks, we recommend a soft diet only. For another 3 weeks, we ask you to do a “knife and fork diet”. This means that your child can start eating whatever foods they like, but it must be cut into small pieces, and they can only chew it with their back teeth.
3-6 months after the bone graft, the orthodontist will order a special CT to see whether or not enough bone has formed in the cleft. Sometimes, if there is not enough bone to support the teeth, a repeat bone graft may be required. Since the bone graft is being placed in between the nose and the mouth, there is also a significant chance that it may become infected. If this happens, it usually does not require intervention other than antibiotics. However, the bone graft may be lost or weak. This would also mean that the bone graft would eventually need to be repeated.