Children with cleft lip and cleft palate may also have a gap in their alveolar bone, the jaw bone that holds the upper teeth. This gap is called an alveolar cleft or alveolar fistula. It can affect how the floor of the nose forms and how adult teeth come in. 

An alveolar bone graft can fix this gap so that your child’s adult teeth can come in correctly. Pediatric plastic surgeons at St. Louis Children’s Hospital perform the procedure as part of the Cleft Palate and Craniofacial Institute team

What’s the Best Age to Have an Alveolar Bone Graft?

The timing depends on each child’s development and the position of their teeth. In general, the best time for surgery is after a child has begun losing baby teeth but before their adult teeth start coming in. Most children we see have surgery between ages 9 and 11. 

Our plastic surgeons work closely with you and your child to determine the best time for your child to have surgery. Before surgery, your child may need to see an orthodontist to be fitted for a brace that will widen the roof of the mouth. This prepares the area for surgery.

What Happens During an Alveolar Bone Graft

The surgeon will take a small amount of bone marrow from the area above your child’s hip. (Our surgeons use a special device for this procedure to decrease incision size and minimize pain, which means that your child will be able to walk immediately after surgery.)
The surgeon will use the bone marrow from the hip to fill in the alveolar cleft. They will then close your child’s gums back around it.

What to Expect After an Alveolar Bone Graft

  • At St. Louis Children’s Hospital, patients usually stay one night in the hospital after we perform an alveolar bone graft.
  • They will need time at home to rest and recover. We’ll prescribe medications to help with the pain and discomfort they will probably feel in their hip or mouth. We’ll also provide complete instructions about keeping the incisions clean and sticking to soft foods for several weeks after surgery. 
  • We typically recommend that they take a week or so off from school. They should avoid sports and other intense activities for several additional weeks. After six weeks, they should be fully recovered.
  • They’ll always have a small scar on their hip where the bone was taken, but it will fade with time.

Why Choose St. Louis Children’s Hospital for Alveolar Bone Graft?

Plastic surgeons focused on children: Our pediatric plastic surgeons focus primarily on treating children and adolescents. This focus gives them an in-depth understanding of children’s anatomy and allows them to tailor surgical plans to children’s needs. 

Expertise with craniofacial anomalies: Our plastic surgeons are part of the Cleft Palate and Craniofacial Institute team, which has treated more than 4,300 patients with cleft lip and cleft palate, and more than 3,000 with major craniofacial anomalies. Their extensive experience means they understand the complexities of alveolar clefts related to other facial anomalies. They can provide your child with a treatment plan that factors in additional surgeries your child has had or will need. 

Dedicated pediatric anesthesiologists: Children and adults react differently to anesthesia. Because our pediatric anesthesiologists treat only kids, they have expert knowledge of children’s unique needs and extensive experience keeping kids safe during surgery.

Faster, safer recovery from surgery: Before and after surgery, we follow a series of specific steps proven to make recovery faster and reduce the amount of opioid painkillers a patient needs. These steps include drinking more fluids before surgery, using alternative pain medications and more. 

Coordinated, convenient care: We’ll do everything we can to make your child’s care as seamless and convenient as possible. That includes working closely with your child’s other providers, such as their orthodontist and primary care doctor. We also aim to coordinate appointments to limit the number of trips you have to make to the hospital.