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Primary Bone Graft

Preparation Before the Surgery for Infancy to Early Childhood

  • 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.

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
  • The surgeon 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 you can go home
  • Surgery is considered out-patient surgery (only in rare circumstances does the child need to stay overnight)

Recovery After 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 Acetaminophen with the Ibuprofen

Antibiotics
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
No restrictions.
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 become dehydrated)
Eating will come as the pain/discomfort gets better after surgery

General Care
Wash and bathe your child normally the day after surgery
There are no restrictions in activities 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 cleaned 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.

Where is the bone taken from?

  • 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 childlike real bone. Bone taken from other people usually is rejected or disappears.

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 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.

Risks, Complications, and Outcome

  • Risks of general anesthesia (discussed by an anesthesiologist)
  • Infection and bleeding
  • Chest wall pleural cavity tear at the time of the rib harvest. Repaired at time of surgery. This would require overnight admission. In over 20 years of surgery, this has not occurred, 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 childhood (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.