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

This one is about: Helping the Bone Graft Be Successful


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****  Helping the Bone Graft Be Successful ****

I asked Dr. Canady questions, primarily because of my interest in ensuring that Jacob's bone graft surgery will have the highest probability of success, and also to share with you on the list. So the information below is what I learned. (with some clearly labeled creative thinking on my part added.)

First, I have long been aware that bone graft surgery has probably the poorest success rate of all the surgeries involved with cleft repair. For many kids, the graft recedes over time.  Up until this year that was just a fact stored away in my brain. But now my son will be having bone graft surgery two weeks from today.  And suddenly I find myself saying, "LOW success rate?!?!?!  GADS - - what can I do to help it be successful?!?!?!

I, of course, asked the new surgeon some questions but I was not satisfied with the answers I got initially, and the next time we were scheduled to see him was the day before the surgery.  Not a good time to get all my questions answered, in my book. And one reason for that is that I wanted to learn what I could do to help Jacob to prepare for a good outcome.

Dr. Canady is the Medical/Surgical consultant for Wide Smiles, and - in my mind anyway - a friend, and somebody I trust.  He was the one I turned to when I didn't get the answers I needed.

Dr. Canady tells me that the single most important factor is to control and, for the most part, eliminate the bad bacteria from the mouth before surgery and during after care.  He suggests, in fact, that the child have a thorough cleaning from a dental hygienist just prior to the surgery.  He also suggests some antibacterial wash and careful brushing up to the surgery and as soon as is allowed after.

He suggested that if there is even the hint of a cold or flu - or any illness beyond ear drainage - that the surgery should be postponed. Not only for the sake of the anesthesia, but also to ensure success of the graft itself.

There have been clinical observations - but no definitive studies done so far - that perhaps the time of year may lend itself to a better probability of success - that being that it has been observed by some practitioners that bone graft done in Spring and Summer tend to take better than grafts done at other times of the year (again, we are not talking definitive study here, but rather clinical observations. There are many successful bone grafts done in the dead of winter, and many unsuccessful grafts done in late Spring. But the hypothesis is, "do bone grafts done during certain months enjoy a higher probability of success than bone grafts done during other months?" and without empirical study yet, some clinicians think yes).  So Jacob's date of July 10 is probably a good one.

Obviously having the child in the best of health before the surgery will also help to ensure success.  So Jacob is getting plenty of sleep with a regular sleeping/waking schedule; lots of physical exercise; and proper nutrition - which is not exactly a detour from normal practices around the Green house.

Now, clearly my own idea here, and one with NO empirical testing behind it - I feel that it makes sense that there be an increase in calcium during this time, so Jacob is drinking at least 2 extra glasses of milk per day. I asked Dr. Canady if it would make a difference, and his response is that nobody has ever studied the effect of calcium  supplement on bone graft success, but it makes sense and it can't hurt.

So, I have already made an appointment for Jacob to have a tooth cleaning on Monday before the Wednesday surgery.  We have switched to an antiseptic mouthwash, which he uses twice per day. And he continues to brush his teeth, using the disclosing tablets to make sure he does a good job. He is drinking extra milk, I am careful about not allowing him to be exposed knowingly to germs (for instance, my niece was sick last Sunday, so I would not allow Jacob to hold her) and he is going to bed earlier than he would like for a summer schedule. He roller skates, swims, and/or rides his bike daily and we take walks together.  He is eating well balanced, nutritious meals.

Given the surgeon's ok, he will do a peroxide/water rinse, followed by a rinse with the antiseptic mouthwash three times per day after the surgery (not a forceful "wash", but rather a gentle rinse.)  And he will follow everything he eats with clear water to help wash away any debris that may collect bacteria.  And, of course, he will continue with extra calcium.

So there it is. Prep before and a plan after. If nothing else, none of this stuff can hurt him - it very well may help him - and both he and I feel good that we can do something to help ensure success. If is does not succeed, we can be relatively certain that it did not fail because there were things we could have done but didn't do.

On the really good news side, Dr Canady tells me that there is a lot being done now to find ways of decreasing the number of graft failures, so that the success rate for this surgery should increase dramatically in the near future - all those of you who will be doing this in years to come. Again, this is still in the research stage, but there's definitely something exciting on the horizon!

Joanne


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