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

This one is about: Do all Cleft Children Need Bone Grafts?

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A question of Bone Graft (excerpted from Cleft-talk):

Why do kids need bone grafts and do all cleft children need them?


What we see when we look at a cleft is the separation of the soft tissue -- the lip, the gum, and the palate. When those are fixed, everything looks good to us -- but what we don't see is the separation in the boney tissue. If you look at a skull, you see a bone the full length under the nasal opening, upon which the teeth are anchored. That is the Maxillary Bone - or upper jaw. With a complete cleft - there is a separation (or two separations) in the maxillary bone. The bone graft is done to fill in the hole left in that bone.

That will do two things for our kids. First - it will cement the dental arch -- meaning, it will permanently affix the horse-shoe shape of the upper gums. Without the bone graft, there will be collapse -- and in fact, there is almost always some collapse before the graft is done (hence the need for palatal expansion). The other thing it will do is provide the bone necessary for the permanent teeth to anchor. Without that bone there, there is a good chance that the permanent teeth will simply get loose and fall out.

If there is a cleft through the alveolar ridge, there is most likely going to be something done to fill that gap in the bone. In past generations, a bone graft may not have been done if the gap was considered "small". But now, something is generally done. But, it may not be a graft...IF the gap seems to be small, the doctors may attempt what is called a periostoplasty at the time of the lip repair.

All of our bones are covered with a thin sheath called the periosteum. The doctor will peel back the alveolar tissue, then open the periosteum of both edges of the cleft, maxillary bone, and stitch the periosteum together. If the edges of the bone are close enough, this may encourage natural bone growth and avoid the need for a bone graft later. There is a high failure rate to this surgery, though, and it only works well when the edges of the bone line up well to begin with.

Hope that answers your question ok.

Joanne Green
Director and Founder, Wide Smiles

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