Your alveolar bone graft operation

Mr Peter Hodgkinson, Consultant Cleft Surgeon for the Northern and Yorkshire Cleft Team, introduces important information about the alveolar bone graft operation.

  • ‘Alveolar’ (alveolus) means gum. The gum is made of bone covered with soft red tissue (mucosa).
  • ‘Bone Graft’ is bone borrowed from another part of the body and used to repair the gap in the gum.

Why do I need this operation?

This is an operation to repair the gap in your gum. Your gum was left unrepaired when your lip was mended when you were a baby. Fixing the gum between the ages of 8 and 12 helps the adult eye tooth (canine) grow straight and strong. It can help the bottom of the nose look a little straighter but it won’t change the shape of your face. For the operation you are asleep under general anaesthetic.

Where does the bone come from?

The bone graft is collected. Marrow bone from the middle of a large bone is best. Often the hip bone is used (sometimes other bones such as the shin, elbow or jaw are used instead of the hip). If the graft is taken from the hip a cut about 5cm long is made low down on your tummy in an area covered by your swimming trunks or bikini bottoms. A window is made in the outer surface of the bone and the inner marrow bone is scooped out. The bone window is closed and the skin is stitched, usually with a buried dissolving stitch. Eventually, the marrow bone grows back and your hip will be as good as new.

How is the bone placed in the gum? Your gum can now be fixed. The mucosa (red tissue covering the bone of the gum) is opened up and peeled away from the bony gap. The mucosa from each side is stitched together with dissolving stitches to make a pocket. The crumbly marrow bone is packed into this pocket so that the entire gap is filled. The mucosa on the front of the gum is loosened and stitched in place to cover up the front of the pocket full of bone.

Will I be uncomfortable after the operation?

Local anaesthetic is often used so your hip and face will feel numb but not sore when you wake up. Your face and gum will feel swollen. There may be some blood in your mouth. Your newly repaired gum is quite delicate but the inside of your mouth must be kept clean. Rinse with water after drinks or food. Bring a soft baby toothbrush into hospital and start brushing your teeth as soon as the doctor or nurse says that this is OK.

You may need to stay in bed for the first day after your operation but should be able to go home after 2 or 3 days.Often where the graft has come from will be a little sore. Activities and sports may be a bit uncomfortable. It may be a few weeks before you get back to doing all the things that you did before. It will take a few weeks for the swelling of your face to go down and for the inside of your mouth to start to feel normal.

6 month Review

After 6 months your orthodontist and surgeon can measure the amount of new bone in the gum using an x-ray. This is one of the ways cleft teams can record how successful your treatment has been.