Cleft Palate Alveolar Bone Graft timing

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.