Most of the time, for a cleft lip & palate patient, at the initial lip and nose surgery (4 to 5 months of age) the alveolus (area of the teeth) is left open to the nose. This is called an oral-nasal fistula. The is a hole from the mouth directly into the nose. Food and liquids can cross through this opening. The opening is not closed until the teeth growing near the opening are getting close to the edge. The opening is closed and bone filled just in time so the teeth grow all the way to the level of the surrounding teeth. This surgery is called an alveolar bone graft. For most children, it is at age 9 to 11. The orthodontist and surgeon will look at the area with x-rays at about age 7 to determine the best timing for the surgery.
Usually, segments of the upper jaw need to be aligned prior to or soon after the surgery to close the opening. After the graft surgery, the upper front teeth can be aligned. The tooth at the area of the graft surgery often is missing or not usable.
To all our patients — During this time of sequestering in our homes to avoid becoming sick, we will only see emergency patients who are in pain. We hope each of you stays healthy. We also hope to be back to making great smiles as soon as possible. …. Dr. Jacob and Staff
Braces do not actually move teeth. They move the bone surrounding the tooth to allow the tooth to move. Cells in your body build new bone, and move bone out of the way. The cells are located in the ligament that holds the tooth to the bone. When the orthodontist pushes on a tooth, these cells are activated in about 12 hours. Then they go to work moving the socket around the tooth.
For teens who will need a jaw surgery with their braces treatment. This treatment usually starts at age 16 1/2 to age 17. The jaw surgery will be 12 to 18 months after the start of braces. The braces will be on the teeth for the surgery as the surgeon will wan to use them for rubber band physical therapy for several months. After the surgery there will be finishing work with the braces. This can take 12 to 18 months depending on what needs to be done.
In general, the surgery is done the summer after high school graduation. We request patients to stay local for the first year or two of college so they can complete the treatment without delays. There can also be a plastic surgery procedure needed after the jaw surgery if the patient has a cleft lip.