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Alveolar Cleft Grafting

Cleft lip and cleft palate are frequent birth defects that cause facial deformities. The defects occur early in prenatal life, when the sides of the lip and the roof of the mouth in a developing fetus do not fuse together as they should. Clefts can be complete or partial, and can occur on one side of the face or on both.

Both of these conditions create serious functional and aesthetic problems in the mouth, the nose and the face that require surgical correction. A cleft palate causes a hole in the hard palate (the bony ridge at the roof of the mouth) and/or the soft palate (the muscle tissue further back in the mouth), and a cleft lip leaves the top lip unfused, and causing an appearance ranging from a small notch in the skin or a complete separation, from the lip to the nose.

The gum supporting the teeth of the upper jaw is called the alveolus. Depending on the severity of the cleft, both a cleft lip and a cleft palate can also cause a disturbance in the alveolus - a hole or gap in the gum-line. This gap is called an alveolar cleft. An alveolar cleft essentially creates an opening between the mouth and the nose, and also prevents the proper growth of the front teeth.

Surgery to correct major defects of clefts in the lip and hard and soft palate is done in infancy - before the age of two. But correcting the alveolar cleft is usually left till a later time, around the age of 8 or 9. This is because if the surgery is conducted when the child is younger than this, the scar tissue that forms during healing will interfere with the normal development of the face. An alveolar cleft is corrected with a graft of bone and soft tissue.

Treatment

Often, before alveolar cleft grafting surgery can be done to close the cleft, the mouth must be widened with an orthodontal brace for several months. Surgery is then done to close the cleft.

The surgery is done under general anaesthesia, and very often requires a night's stay in the hospital. First, bone is taken from another part of the patient's body (often from a bone in the hip or shin). The soft tissue (gums) is lifted, and the new bone is then grafted to the existing bone in the patient's upper jaw. The gum is then replaced and the incision is sewn closed.

Over the next weeks to months, the grafted bone becomes incorporated into the patient's own bone tissue. Gradually, normal permanent teeth will be able to erupt through the graft. Most often, after all the permanent teeth have come out, patients will need to get braces to straighten them.

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