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

This one is about: A Regimen for Successful Bone Graft Surgery


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STACKING THE DECK IN FAVOR OF SUCCESS

A Regimen for Successful Bone Graft Surgery
by Joanne Green

Bone graft surgery has probably the highest failure rate of all the surgeries our children face. In fact, a bone graft that is only partially successful is considered to be a success. You end up with more bone than you started with.

What happens? A lot of things - but the end result is that the bone fails to "take" and then recedes and is absorbed by the body.

When Jacob faced his bone graft surgery last July, I was concerned that I (we) do everything we could to increase the probability of success. Things didn't look good. Even though Jacob's cleft never seemed particularly wide, he is missing three permanent teeth - - translate that to mean - lots of missing bone. And as it turned out, the gap in the bone was in fact, huge. Probability of 100% success was dismal.

I asked some questions, did some research, and ON MY OWN, I instituted a program for enhancing the success of this upcoming operation. And I now share that program with you.

First, I learned that the biggest threats to the bone graft are blood supply, trauma and infection. I also learned that it takes three full months for the bone to fully heal or to fully "take". I got some advice and I pieced together some of my own.

I reasoned that if we were going to enhance success, we would have to start early. We wanted to go into the surgery with an immaculate mouth (as close to bacteria-free as possible) Careful attention was paid to brushing and flossing. We switched to an antiseptic mouthwash and an antiseptic toothpaste. (Dr. Kirt Simmons, Orthodontic consultant for Wide Smiles suggests making this switch relatively close to the surgery date so as not to encourage antiseptic-resistant bacteria.) And we scheduled a cleaning by a dental hygienist the day before the surgery.

I also decided on my own (no empirical evidence here, but it made sense to me) that if he was going to build bone, he needed the calcium to do that. I wanted a healthy donor site and I wanted plenty of building blocks in his system for the graft site. We increased his milk intake by at least 1 tall glass of milk per day, plus he began eating one calcium-rich antacid each day (for the calcium). We began this a few weeks before the surgery.

I also heard that it was a clinical observation (again, not based on empirical evidence - just an observation made by doctors and teams) that bone graft surgery done in the Spring or Summer months tend to have a greater probability of success. The surgery was scheduled for July 10. No problem there.

When the surgery was done, I felt we were ready. Two hours in the OR, followed by 10 hours of peacefully sleeping it off, Jacob woke up in good spirits. He began right away "eating" his liquid diet (jello, ice cream, pudding - life is rough, isn't it?) As soon as he ate something, he got up and we walked to the pay room. Next day, he went home. We are talking 28 hours in the hospital - tops!

At home, my aftercare was even more strict than that ordered by the doctor. Each morning, noon and evening, Jacob rinsed his mouth with an antiseptic mouthwash and followed it with a rinse of a peroxide and water solution. This was just a gentle swish - not a hard washing. He followed every meal with a slightly warm salt water rinse. He followed anything by mouth immediately with a drink of clear water. This was all done to ensure a clean graft site. When he was again able to brush his teeth, we went back to using the antiseptic tooth paste.

All of his meals were either liquid to start with, or blended to a liquid in the osterizer. I always used milk to blend his foods, as opposed to water. I also added yogurt to a lot of his foods (yogurt has a higher calcium content than milk).

To avoid trauma to the site, his activities were curtailed. At first books, videos, TV, and table games made up his activities. Then as he healed, he could play more, but I still did not allow his bicycle, skateboard, roller skates, ball games, or anything that could result in trauma either to his hip or to his face for a FULL THREE MONTHS.

It was an eternity to a child of nine, but in my opinion it was no more an eternity that that wait in the little room is for me when my baby is repeating surgery that could have been avoided!

Jacob was given the go-ahead to eat "regular food" after two weeks. I said no. He could chew again, but only if there was no resistance. No hard or crunchy foods allowed for three months! My rule. You can bite down on a hard food with an awful lot of destructive force.

When the doctor said "ok to eat normally", Jacob clapped his hands. Then I said, "No. Nothing hard or crunchy for three months." He looked at his doctor and the doctor said, "Listen to your Momma. She is right."

Many times a parent will plead with a doctor to lighten up on the regimen a bit. And many times the doctor's instructions are such that they realize the family is going to "cheat", so they lift the restrictions at a compromised time (holding off long enough to ensure REASONABLE success, but not as long as they would like.) My opinion is - it's only food. And if we screw this up, it's another surgery. So in what must have been the strangest move my plastic surgeon has ever seen, I insisted on more precautions than he ordered.

The mouth washing continued. The calcium supplement continued. The precautions against trauma continued. And I shielded my healing son from anyone with a cold or flu.

Three months later, the orthodontist ordered x-rays. My stomach was in knots. I prayed for good results. And when Jacob came out, my orthodontist had the widest smile on his face. "It looks like the graft is 100% successful." he said. "The doctor did a great job!" Well, I thought, it was a team effort.

I hope those who are facing bone graft will find this helpful. I realize the regimen is a difficult one, but success is difficult to achieve. I have at least two more bone grafts to go (one with Joey and one with Jessica). Believe me, the rules will be the same.

You can see a photo journey of Jacob's bone graft experience on the Wide Smiles photo gallery on the World Wide Web. Go to http://www.widesmiles2.org/gallery and click open Jacob's Bone Graft.


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