Instructions after Bone Graft Surgery
Important information about bone graft surgery:
Bone grafts are used to fill in for the bone that is not present in the gum area of the cleft, also known as the alveolus. Small pieces of bone from another part of the body, usually from a part of the hip called the iliac crest, are put into this space. The small amount of bone that we remove from the hip will not affect the function of your child’s hip or leg. We will close the gum incision with dissolvable sutures. The bone grafts that we place will continue to grow inside the cleft and form a new bone over time. Filling the gap helps to support your child’s teeth. This helps the teeth to stay healthy. This graft also supports the side of the nostril and makes for easier mouth care.
Instructions before surgery
A CT scan of the gum line is usually needed before surgery to see how much bone is missing. This can be done in the CHOP orthodontics office or at your local orthodontist if they have the right type of scanner and they can provide the CT scan images.
We will give your child a prescription for a medicated mouth wash, Peridex™ (clorhexidine glucanate oral rinse), to use for 2 weeks before surgery and for 30 days after surgery. This mouthwash will decrease bacteria in the mouth, which is important for lowering the risk of infection. Your child will need to swish and spit 5 ml (1 teaspoon) of the mouthwash 4 times a day, after each meal and then again before bedtime.
Instructions after surgery
Drinking and eating
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Your child will have an IV after surgery and it will be left in place until your child is drinking well.
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Your child will begin with a clear liquid diet taken from a cup on the day of surgery, this includes Jell-o® and water ice. The day after surgery your child will be allowed to start eating soft foods. These can be ordered from the hospital room service menu and includes foods such as well-cooked pastas, macaroni and cheese, finely ground beef, blenderized foods, pancakes, soft bread, eggs, cottage cheese, and tuna or egg salad (finely chopped). Your child should stay on a soft diet for 3 weeks after surgery. Your surgeon will discuss further diet changes at the first post-operative appointment.
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Do not use straws for 3 weeks after surgery.
Safety
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Your child will have a splint made to protect their gums. This will be made by an orthodontist before surgery. You will need to meet with the orthodontist to have the splint made and then again just before surgery to try on the splint. You will need to bring the splint with you on the day of surgery.
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Do not remove the splint for 5 days after surgery. Your child must keep it in at all times, including at night and during meals.
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The orthodontist will give you specific details about wearing the splint. Most children wear the splint for at least part of the day for 6 months after surgery.
Wound care
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The stitches in the gum will dissolve; they do not need to be removed.
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Do not brush the upper teeth for 5 days, while the splint is in continuously. You should brush the lower teeth normally. After the splint is removed, use a soft toothbrush or wet gauze with toothpaste to clean upper teeth. Do not brush the gums. You may brush all of your child’s teeth after 1 month, unless directed otherwise at follow-up visits.
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Remove the dressing from your child’s hip 2-4 days after surgery. It is normal to see a small amount of bloody drainage on the dressing. If there are small pieces of paper tape, called Steri-Strips™, over the hip incision, leave these in place for at least 1 week after surgery. After 1 week, you may remove them gently in the bath or shower with soapy water.
Activity
Your child may not participate in gym, swimming, or sports for 1 month after surgery.
Pain management
Your child may be in pain after surgery, but most pain can be well controlled. Sometimes we cannot help a child to be completely pain free, but we will help your child to be as comfortable as possible. During surgery, long-acting pain medicine was placed in the surgical sites to make these areas less painful after surgery. This medicine lasts 6 to 12 hours after surgery. Your child may have numbness and tingling at the surgical sites because of this medication.
If at any time your child’s pain is not relieved with ibuprofen:
If at any time your child’s pain is not controlled by either ibuprofen or acetaminophen alone:
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You can alternate doses of acetaminophen and ibuprofen every three hours. For example, if you give your child acetaminophen at noon, you can give ibuprofen at 3 p.m. and then acetaminophen again at 6 p.m. and ibuprofen again at 9 p.m. It is very important that you read and understand the dosing instructions of both medications. You may not give more than 4 doses of ibuprofen in a 24 hour period. You may not give more than 6 doses of acetaminophen in a 24 hour period.
If at any time your child’s pain is not controlled with alternate doses of acetaminophen and ibuprofen:
Discharge
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Your child will be discharged home when they are drinking, breathing easily, and feeling comfortable. This usually happens in 1 to 2 days.
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Schedule a follow-up appointment with the plastic surgeon and the orthodontist 2-3 weeks after surgery.
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A follow-up CT scan of the gums approximately is usually done 6 months after surgery to make sure that all the bone placed in the gum line has remained healthy.
Complications
As in any surgery, rare problems can occur which include bleeding, infections, breakdown of the repair, and reactions to medicine. These problems are uncommon, and most of the time bone graft surgery has good results.
Contact your CHOP surgical team with questions, concerns or if your child:
Monday through Friday, 8 AM -5 PM
215-590-2208
Evenings, weekends, and holiday, call 215-590-1000 and ask to speak with the plastic surgery resident or fellow on call
Reviewed December 2023 by Kelsey Reilly, CRNP