You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Failed Bone Graft/Jaw Surgery


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*** Failed Bone Graft - Comments by Dr Simmons on suggested jaw surgery ***

>I am the mother of a 9 year old girl who was born in Korea with a complete
>cleft of the lip and palate. At this point her lip and palate have been
>repaired beautifully and we are in the midst of orthodontics. Last summer
>she had her bone graft and all seemed to go well. In spite of our care the
>graft failed at the end of six months. This has been our first cleft-repair
>setback which leads to my question.

>Question about moving the jaw:

>At this time, rather than repeat the graft her orthodontist suggest that we
>allow all her teeth to erupt and then move her upper jaw over to close up
>the gap. Has anyone out there had this done? Is this what is called a
>jaw advancement?

Haven't had it done but it is NOT an uncommon procedure in CA kids- I'm a little unsure as to what you mean when you say the graft "failed"- this could mean a number of things from complete failure (ie situation same or worse than pre-graft) to inadequate for movement/eruption of teeth in the area. I would assume this orthodontist has experience with CA kids - the critical thing now would be proper eruption of adjacent teeth - surgery later cannot really address this. Moving the upper jaw "over" could mean advancement (ie moving the jaw forward) or moving it laterally (ie moving it sideways towards the other part of the jaw to close the cleft). Quite often an upper jaw advancement is necessary to position the upper jaw in an ideal position relative to the lower jaw. This appears to be due to a restraint of growth of the top jaw by the scar tissue from the palate repair in the back of the top jaw and/or the lip repair at the front of the top jaw (ie upper lip tight and "stretched" over front of top jaw). These don't seem to affect growth of the bottom jaw as much and so the top jaw can end up too far back (and too "skinny") for the bottom jaw.

>What is the surgery like for the child and how long is the recovery?

It is a major craniofacial surgery, will be in the hospital several days and swollen and uncomfortable for couple of weeks. Some patients report it's not as bad as having your wisdom teeth removed however, if you can relate to that.

Kirt Simmons DDS, PhD


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