Pre-op Appointments, Alveolar Bone Graft

Today we had Rachel's Pre-Op appointments at the Children's Hospital in Seattle.  We saw the Social Worker, the Intern, the Surgeon, and the Nurse.  Made for a long morning.  Everything went smoothly with the exception of the terribly lacking bedside manner of the Intern.  I am going to cut him a bit of slack considering it was very clear that English was not his first language, but seriously, using the word "pain" repeatedly when talking to a child is just not a good idea.  This is a teaching hospital so you are always going to see interns, comes with the package of your "team", but really, they need to make sure they have enough adjectives on board so that they can avoid using ones that cause little kids' eyes to go like saucers...  our surgeon was much better using the words "ache" and "uncomfortable".  Those she could deal with.  We were also lucky enough to sweet talk our Nurse into calling her Head Nurse friend down in the surgery center and hook us up with a little tour of an empty room.  This really seemed to put a lot of Rachel's fears to rest, being able to see where she would sleep, where I would sleep, the bathroom, etc.  Didn't look one bit scary after all :-)

So, what is an alveolar bone graft anyway?

Some children with cleft lip (or cleft palate) also have a cleft or gap in the bone of the upper jaw that holds the teeth.  This bone is called the alveolus (al-vee-OH-liss).  An alveolar bone graft is a surgery to fill the gap in the bone of the upper jaw. To fill this gap, a small amount of soft bone is harvested from the hip and transplanted into the jaw structure. They usually harvest bone from the left hip (where the point sticks out in the front) as it's on the opposite side of the table from the anesthesia people and everyone has more room to work, go figure. Then they cut open the gum, pack the harvested bone inside, then sew up the gum around it and also the incision in the hip. Upon healing, the new bone hardens and then becomes part of the complete upper jaw. (The new bone and the bone that was taken from the hip heal and grow back in about six weeks.)

So this is what it looks like on paper at this point:

One week before surgery - No Ibuprofen or aspirin (tylenol is ok).  No shaving near incision site (shouldn't be a a problem for a six year old girl). No getting a cold or any type of illness, if so surgery will have to be re-scheduled. (maybe I should have her tele-commute to school... she seems to catch every little thing..)

Two days before surgery - start using prescription antibiotic mouthwash and nose prep solutions. (This should be fun for a girl who only tolerates berry toothpaste).

Day before surgery - get the big phone call as to what time her surgery will be, what time she has to stop eating and drinking, etc. 

Night before or Day of surgery - Wash/scrub thoroughly with Hibiclens solution from the  neck down for five full minutes.  This is to decrease the number of germs (!) on your child before surgery, hopefully decreasing the chance of infection.

Day of surgery - show up with a smile on your face (fake it till you make it!) Totally unrelated side note: This is scary crazy.. female patients above the age of 12 are required to give a urine sample to screen for pregnancy. 12!!!!  Llalalalala I can't hear you..... can you even imagine?)

Surgery should take less that two hours, with another two or so in recovery.

Expect to spend at least one night in the hospital, possibly two depending on if the child is able to walk, pain is controlled, is taking fluids by mouth, etc.

After surgery expect your child's hip to be more sore than their mouth.  Expect their face to be quite swollen (she'll be little Rachel Who from Whoville).  Pain meds will be by I.V. initially, then by mouth as time progresses.

After surgery she will be able to drink clear liquids for 24 hours, followed by any liquids the following 24 hours.  After that a NO-Chew soft food diet for about six weeks. Looking over the list of approved foods made me laugh out loud.  This is going to be..... challenging.  Maybe the picky eater will just get really hungry and surprise us both???  Either that or I'm buying a lot of ice cream next month.

Pain should lessen in a few days, but expect a sore hip when walking for several weeks.

Will continue using special mouthwash and use a baby toothbrush to brush teeth, gently clean graft site.

No baths for at least two weeks (this will be hard for my bath girl)

No school for a week to 10 days.

Upon returning to school there will be: No riding the school bus, no eating lunch in the lunch room, no P.E. class, and no recess for six weeks.  Obviously, no rough-housing with Dad or running, jumping around at home either. :-)

So.

So.  Sounds like a piece of cake, right?  

Click here to read about the first 24 hours.

Comments

[Lisa]

I'm not sure who you are, but tonight you are my angel. I found this post during a google search. My daughter will be having this surgery in October and you have now answered more questions for me than her surgeon has so far! I appreciate your attitude and positive tone. My daughter shares many attributes with your daughter: loves baths, picky eater, only uses berry toothpaste! Please let me know how it all went and give me some pointers. Real parents who have gone through this have the answers. Thanks so much!

[Ruth Taylor]

Thank you so much for the wonderful posts about your brave little girl. My 9 year old daughter will be having her bone graft surgery on July 5th. But I am very worried because she also has autism and can't stand stitches in her mouth. Three weeks ago she pulled the stitches out of her mouth after dental surgery and she pulled her cemented palatal expander out of her mouth. When did the stitches fall out of your daughters mouth?
Thanks again,