As for the next steps in her cleft repair, they are planing to remove an adult tooth that has decided to erupt into her cleft line. This will be taken out sometime this fall and then they will proceed with her bone grafting/cleft repair in the Spring of 2013 at the age of five and a half. This is much earlier than we thought, but they all agree that it is in her best interest. Then, about 6 months after the bone graft (Fall 2013) the plastic surgeon will touch up her lip and nose again and anything on her palate that needs to be touched up. Also during this time she will start her orthodontic journey by getting molds made of her teeth and inserting a palate expander. This includes the use of headgear during the night to pull her upper jaw forward. He says it will all move pretty quickly into the proper position because she is young, but warned that kids with clefts often have to repeat this as their palates tend to migrate back to where they were. He also warned that the palate expansion could stretch the bone grafting and cause some problems in that area. With all the possible complications, they still think it is best to start this earlier than later. He explained that even up to five years ago, they used to perform the palate expansion first before the bone graft, but the problem was that the cleft becomes to wide and that the bone grafts don't take as easily. I would love to hear from others that have had their bone grafts done around age five and how they have worked out.
