Alveolar Cleft Repair: Part 3

Details about the Procedure

In this post, I will provide an accurate description of the procedure that Levi went through.  There are some anatomical images, so just take that into consideration if you prefer not to see those types of images.

 

The term “alveolus” can be confusing, as it is used both in reference to the lungs and in reference to dentistry.  For my purposes, any use of “alveolar” or “alveolus” here is in reference to the bony socket for the root of a tooth.  The alveolar bone is shown in green on the image of the skull.

The following x-ray is not of Levi’s mouth, but it is very similar to how his bone structure looked prior to this repair.  His cleft lip and palate were on the left side of his mouth, with the cleft extending from the back of his hard palate (the roof of his mouth) up through his alveolar bone (gum line).  The repair was necessary to provide bone tissue so that his adult teeth will have somewhere to grow down into.

Here is a very simple image and explanation of what the surgery was all about.  Read on further for a more detailed explanation of what the surgeons did.  

Step one of the repair was to harvest some bone tissue from Levi’s hip.  They used bone from his iliac crest (highlighted in red on this photo).  They used his left side, which conveniently was the side Levi was hoping they would operate on!  We asked why they chose to use Levi's left hip, and the surgeon said that partly it was convenience of positioning during the surgery, but also that most kids are right side dominant.  Using the left side means he will be able to take full strength kicks, etc. with his right leg once he's cleared for physical activity again.  The bone from his hip will take about 5 years to grow back completely. 

The surgeon said the piece of bone they took was about 2.5 x 3 cm.  They also harvested some marrow.  The bone they took was slightly malleable (about the firmness of the green scrubbing side of a kitchen sponge), so they could mold it into the gaps in his mouth.  

The bone was placed in the proper position, and sutures were used to close the gum tissue around it, as is shown in the image below.  The surgeon said Levi has about 100 sutures in his mouth, which are thankfully absorbable.   

Levi is not supposed to brush his teeth right now, but uses both a medicated oral rinse twice a day, and a basic salt water rinse a couple times during the day.  

We are so thankful for the medical team that was involved with Levi’s procedure.  This surgery has been on our minds for a long time now, and we’re happy to have it completed and to move on to the next stage... which is braces!

Currently, we’ll focus on healing and recovery, and then in a few months we will start his braces journey!  

 

For further reading about cleft lip and palate, and more details about alveolar bone repairs, the following websites are some of the most informative that I have found. 

 

https://www.craniofacialteamtexas.com/cleft-lip-and-cleft-palate/what-causes-cleft-lips-and-palates/

https://www.texaschildrens.org/departments/cleft-lip-and-palate-clinic/alveolar-bone-graft

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706037/#:~:text=There%20are%20several%20different%20graft,a%20process%20called%20creeping%20substitution.