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At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this surgery and invite you to participate. Please read the following information to learn about the surgery and how you can help.
Some children who are born with both a cleft lip and a cleft palate also have a problem with the alveolar (al-vee-OLE-ar) bone, which makes up the gum ridge or front portion of the roof of the mouth. The alveolar bone is a thin layer of bone that forms the sockets around the roots of the upper teeth under the gum tissue.
When there is a cleft in the alveolar bone, it means there is a fistula (FIST-yoo-la) or hole from the mouth to the nose. This cleft in the bone and gums prevents teeth from growing properly and the floor of the nose from developing normally. Fixing the cleft to allow for proper tooth development is important to a child’s health because missing teeth can have a negative effect on eating, digestion, facial growth and appearance. In addition, a child’s smile is an important part of his or her personality, and missing or poorly aligned teeth can have a huge negative impact on a child’s self-esteem.
The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. The surgery usually is done when the child’s permanent canine teeth are three-quarters formed.
To do the bone graft, a piece of bone usually will be taken from your child’s iliac (ILL-ee-ack) crest, the upper ridge of the hip bone. The doctor will make a 1- to 3-inch incision (in-SIZZ-yun) or cut in the skin just over the hip bone and in the bone itself to remove the inner portion of the bone. This part of the bone, called cancellous (CAN-sell-us) bone, is soft and pasty and can be shaped to form the patch that will close the hole in the alveolar bone. Gum tissue inside your child’s mouth then will be closed around the bone and sutures (SOO-chers) or stitches will hold the tissue in place as it heals.
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions. If these instructions are not followed exactly, it is likely your child’s surgery will be cancelled.
Your child’s alveolar bone graft will be done at the Same Day Surgery Center at Children’s Hospital in Lawrenceville. When you have checked in at the Same Day Surgery Center, you and your child will be called to an examination room where your child’s health history will be taken and vital signs will be checked.
You will meet with one of the doctors on your child’s surgical team to go over the surgery. He or she will answer any last-minute questions you might have at this time. A member of the anesthesia staff also will meet with you and your child to review his or her medical information and decide which kind of sleep medication he or she should get. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
When it is time for your child to go the operating room, you will be asked to wait in the surgical family waiting area.
The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm. During the surgery, at least one parent or guardian should remain in the surgical family waiting area at all times, in case the family needs to be reached.
While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously. To keep your child asleep during the surgery, he or she may be given anesthesia medication by mask, through the IV or both. When the surgery is over, the medications will be stopped and your child will begin to wake up.
When your child is moved to the recovery room, you will be called so that you can be there as he or she wakes up.
After the surgery, and for the weeks afterward at home, your child will only be allowed to drink liquids or semi-liquids from a cup. No utensils or straws should be used until your child’s surgeon says it is OK.
A complete list of instructions for taking care of your child at home will be given to you before you leave the hospital. The main things to remember are:
If your child has any special needs or health issues you feel the doctor needs to know about, or if you have any questions, please call 412-692-8650 before the surgery and ask to speak with the nurse practitioner or cleft clinic coordinator. It is important to notify us in advance about any special needs your child might have.
To contact your child’s surgeon, call 412-692-7949. If you are unable to reach the surgeon, or it is after hours, call the Children’s operator at 412-692-5325 and ask to page the doctor who is on-call for your child’s surgeon.
Children's Hospital's main campus is located in the Lawrenceville neighborhood. Our main hospital address is:
UPMC Children’s Hospital of Pittsburgh
One Children’s Hospital Way
4401 Penn Ave.
Pittsburgh, PA 15224
In addition to the main hospital, Children's has many convenient locations in other neighborhoods throughout the greater Pittsburgh region.
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