Disease of the Cleft of the Alveolar Process of the Maxilla

Disease of the cleft of the alveolar process of the maxilla usually means all the problems related to a bony gap in the tooth-bearing part of the upper jaw (the alveolar process) that happens as part of a cleft lip and/or cleft palate. In this condition, the bone that should support the upper front teeth is not continuous, so there is a cleft (opening) that may also connect the mouth and the nose.

The “cleft of the alveolar process of the maxilla” is usually called an alveolar cleft. It is a gap in the upper gum and jaw bone (alveolar process) where the front teeth should grow. It often happens together with cleft lip and/or cleft palate. Because the bone and gum are split, teeth near the cleft may not erupt properly, food and fluids can leak between the mouth and nose, and the upper jaw can be weak or narrow. [1]

Alveolar cleft is a congenital condition, which means the baby is born with it. It comes from problems in facial development in early pregnancy. Most children need long-term care from a cleft team – surgeons, orthodontists (braces doctors), speech therapists, dentists, nutritionists and psychologists – from birth to the end of growth. [2]

The alveolar process is the ridge of bone that holds the teeth. When a cleft passes through this ridge, it can cause missing or misplaced teeth, trouble with biting and chewing, leakage of food or fluid between the mouth and nose, speech problems, and a higher risk of dental disease. This cleft is present at birth and is part of the group of conditions called “orofacial clefts.”

Children with a cleft of the alveolar process of the maxilla often need long-term care from a cleft team, including surgeons, orthodontists, dentists, speech therapists, and sometimes psychologists. A key treatment is alveolar bone grafting, where bone is placed into the gap to rebuild the ridge and support the teeth.

Other names and related terms

Many different words are used for the same basic problem. These are some common names and related terms and what they mean:

1. Cleft alveolus – This term means a cleft (gap) in the alveolar bone of the upper jaw. It is the simplest and most direct name for a cleft in the tooth-bearing part of the maxilla.
2. Alveolar cleft of the maxilla – This name emphasizes that the cleft is in the maxillary (upper jaw) alveolar process. It is often used in surgical and orthodontic papers about bone grafting.
3. Cleft lip and alveolus – This is used when the cleft involves both the upper lip and the alveolar ridge but may or may not include the palate. It describes the combination of soft tissue (lip) and bone (alveolus) involvement.
4. Cleft lip, alveolus and palate (CLAP) – This term is used when the cleft runs through the lip, the alveolar bone, and the hard palate and may extend into the soft palate. This is one of the common patterns seen in cleft centers.
5. Residual alveolar cleft – This term is used when a cleft remains or reopens in the alveolar area after earlier cleft surgeries, such as lip or palate repair, and may need later bone grafting.
6. Alveolar bone defect in cleft lip/palate – Many articles talk about “alveolar bone defect” rather than “cleft,” but they are describing the same bony gap that needs reconstruction.
7. Secondary alveolar cleft defect – This phrase is used when the cleft is treated with a secondary bone graft, usually in the mixed dentition stage (around 7–11 years of age).

Types of disease of the cleft of alveolar process of maxilla

Doctors describe several types or patterns of alveolar cleft. Understanding these types helps with planning treatment and explaining the condition to families.

Isolated cleft alveolus – In some patients, the cleft affects mainly the alveolar bone and the adjacent gum, with little or no involvement of the hard palate. The lip may or may not be affected. These cases still have the same problems with tooth eruption and bone support.

Cleft lip and alveolus without cleft palate – Here the cleft runs through the lip and then through the alveolar process but stops before the hard palate. These children usually have better speech outcomes than those with palatal clefts, but dental and nasal problems can still be significant.

Cleft lip, alveolus and palate – In this type, the cleft starts in the lip, passes through the alveolar bone, and continues through the hard and often soft palate. It is one of the most common patterns and is associated with more complex feeding, speech, and dental issues.

Unilateral alveolar cleft – The cleft is present on only one side of the upper jaw, usually on the left side more often than the right. This may cause asymmetry of the nose, lip, and dental arch.

Bilateral alveolar cleft – The cleft is present on both sides of the upper jaw, often with a central bony segment (the premaxilla) that is mobile or displaced. These patients often have more severe dental and skeletal problems and may need more complex surgery.

Complete alveolar cleft – The full height and width of the alveolar bone is involved, and there is a true gap from the gum margin up to the nasal floor. This type often needs well-planned bone grafting to restore continuity and support for tooth eruption.

Incomplete alveolar cleft – Only part of the alveolar process is split, and some bony bridge remains. The dental and speech problems may be milder, but orthodontic treatment is still often required to guide tooth positioning.

Residual or recurrent alveolar cleft after grafting – Sometimes the first bone graft resorbs or does not fully fill the cleft. In these cases, a residual defect remains and can again cause fistulas, poor tooth support, and need for revision grafting.

Causes of disease of the cleft of alveolar process of maxilla

The cleft of the alveolar process is usually present at birth and is caused by problems in facial development in the early weeks of pregnancy. It is almost always multifactorial, meaning that several genes and environmental factors work together.

1. Genetic susceptibility in cleft-related genes – Variants in genes such as IRF6, TGFA, and others involved in facial development can increase the chance of an oral cleft, including an alveolar cleft, especially when combined with environmental triggers.

2. Chromosomal abnormalities – Certain chromosomal disorders (for example trisomy 13 or 18) often include cleft lip, alveolus, and palate as part of a broader syndrome, so the alveolar cleft is one feature of a more general developmental problem.

3. Family history of cleft lip and palate – Having a close relative with an orofacial cleft increases the risk for future children, showing that inherited factors are important in the formation of the alveolar cleft.

4. Consanguineous marriage (parents closely related) – Studies from some regions suggest that marriage between relatives may raise the risk of clefts, possibly because shared genes for susceptibility are more likely to come together in the baby.

5. Maternal folate deficiency – Low folic acid or poor folate metabolism in early pregnancy has been linked with a higher risk of oral clefts, including defects in the alveolar process, similar to its role in neural tube defects.

6. Maternal vitamin B12 and other micronutrient deficiencies – Lack of vitamin B12 and other key nutrients during the first trimester can disturb cell division and tissue fusion in the forming lip and maxilla, making a cleft more likely.

7. Maternal smoking during pregnancy – Tobacco smoke exposes the fetus to many toxic chemicals that can interfere with normal facial fusion, and multiple studies show higher cleft risk in babies of mothers who smoke.

8. Maternal alcohol use – High alcohol intake in early pregnancy can cause fetal alcohol spectrum disorders, and cleft lip and palate, including alveolar clefts, can be one of the facial features.

9. Use of teratogenic medicines in early pregnancy – Some antiepileptic drugs, retinoic acid derivatives, and other teratogens are linked to oral clefts, especially when taken during the critical weeks when the lip and palate are forming.

10. Maternal diabetes (poorly controlled) – Pregestational or poorly controlled gestational diabetes is associated with a higher risk of congenital malformations, including cleft lip, alveolus, and palate, due to altered fetal growth and metabolism.

11. Maternal obesity – Higher maternal body mass index has been associated in some studies with increased risk of orofacial clefts, possibly through metabolic, hormonal, or inflammatory pathways.

12. Maternal infections in early pregnancy – Infections such as rubella, influenza, or other systemic illnesses during the first trimester may interfere with normal embryonic development and increase the chance of clefts.

13. Environmental toxins and pesticides – Exposure to certain industrial chemicals, solvents, or agricultural pesticides has been reported as a possible risk factor for clefts, especially in areas with high environmental contamination.

14. Severe maternal malnutrition – Poor general nutrition and low protein-energy intake in early pregnancy may disturb tissue growth and fusion of facial processes, contributing to alveolar clefts.

15. High altitude or chronic hypoxia – Living at high altitude or having maternal conditions that reduce oxygen delivery to the fetus may play a role in some populations by affecting blood flow to developing facial tissues.

16. Advanced maternal age – Older maternal age is associated with increased risk of many congenital anomalies, including some types of oral clefts, possibly due to accumulated genetic and environmental factors.

17. Paternal smoking and environmental exposure – Paternal smoking and workplace exposures to certain chemicals can affect sperm quality and may slightly increase the risk of clefts in offspring.

18. Syndromic disorders (for example, Van der Woude syndrome) – In some families, a specific syndrome with known gene changes (such as IRF6-related Van der Woude syndrome) has cleft lip, alveolus, and palate as a typical feature.

19. Mechanical factors in the uterus – Rarely, conditions such as amniotic bands or severe uterine constraint may disturb normal facial development and contribute to cleft formation.

20. Unknown or idiopathic causes – Even with detailed study, no clear cause is found in many cases. The alveolar cleft is then considered to be the result of complex interactions of many small genetic and environmental factors that we cannot fully measure yet.

Symptoms and signs

The disease of the cleft of the alveolar process of the maxilla produces a mixture of visible changes in the face and mouth, dental problems, and functional difficulties with feeding and speech. The exact pattern depends on whether the lip and palate are also involved and whether surgery has been done.

1. Visible gap in the upper gum ridge – The most obvious sign is a clear split or gap in the gum behind the upper lip, where the tooth-bearing ridge should be continuous. This gap may connect directly to the nose cavity.

2. Missing teeth near the cleft – Teeth that should develop in the cleft area, especially the lateral incisors, are often absent, which affects chewing, appearance, and speech.

3. Extra or malformed teeth – Some patients have extra (supernumerary) teeth or teeth with abnormal shape near the cleft, which can complicate orthodontic treatment and increase the risk of dental caries.

4. Teeth erupting in the wrong place – Teeth may erupt into the cleft or in a very displaced position because the normal bony path for eruption is missing, leading to orthodontic crowding and poor alignment.

5. Malocclusion and bite problems – The upper jaw may be underdeveloped or asymmetric, and the teeth do not meet properly, causing open bite, crossbite, or severe crowding that affects chewing and facial balance.

6. Difficulty feeding in infancy – Babies with an alveolar cleft, especially if the palate is also cleft, often struggle to create suction, so breastfeeding and bottle-feeding can be difficult, and they may need special bottles or feeding techniques.

7. Milk or food leaking through the nose – Because the cleft may connect the mouth and nasal cavity, liquid can escape from the mouth into the nose and come out through the nostrils, especially before repair.

8. Frequent nasal discharge and infections – The open passage between mouth and nose can allow food and bacteria to enter the nasal cavity, leading to chronic nasal discharge, crusting, and recurrent infections.

9. Speech problems, especially hypernasal speech – Air leaks through the nose during speech, causing a nasal sound quality (hypernasality) and difficulty pronouncing certain consonants, particularly if the palate is also affected.

10. Difficulty with blowing, whistling and some sounds – Children may find it hard to blow air through the mouth alone, to whistle, or to make pressure-dependent sounds like “p,” “b,” and “t,” because the cleft reduces oral air pressure.

11. Recurrent ear infections and hearing problems – Cleft palate and upper jaw deformities can disturb the function of the Eustachian tube, leading to fluid in the middle ear, repeated ear infections, and sometimes conductive hearing loss.

12. Nasal deformation and facial asymmetry – In unilateral clefts, the nostril and nasal base on the cleft side may be flattened or pulled up, and the upper jaw may appear twisted, causing visible asymmetry of the face.

13. Drooling and poor lip seal – When the lip is also cleft or scarred after surgery, the child may not be able to close the lips fully, leading to drooling and difficulty keeping saliva and food inside the mouth.

14. Food trapping and dental decay around the cleft – Irregular tooth positions and scarred gum tissue make cleaning difficult, so plaque collects, and there is a high risk of dental caries and gum disease unless dental hygiene is excellent.

15. Psychosocial stress and low self-esteem – Visible facial differences, speech difficulties, and dental problems can cause teasing, social withdrawal, and emotional distress, especially during school years and adolescence.

Diagnostic tests for disease of the cleft of alveolar process of maxilla

Diagnosis is usually clinical, because the cleft is visible at birth or soon after, but many tests are used to fully understand the defect, plan treatment, and check results of surgery and orthodontic care. These tests can be grouped into physical exams, manual tests in the mouth and face, laboratory and pathological tests, electrodiagnostic tests, and imaging tests.

Physical examination tests

1. General physical examination and growth assessment – The doctor looks at the baby or child as a whole, checking weight, length/height, head size, and general health. This helps to detect any associated syndromes or other birth defects and to see whether the child is growing well despite feeding challenges.

2. Facial inspection and symmetry assessment – The clinician examines the face from the front and side, noting the size and shape of the nose, lips, and jaws, and checking for asymmetry between the cleft and non-cleft side, which is important for planning surgeries to improve form and function.

3. Intraoral examination of the alveolar cleft – With a light and mouth mirror, the doctor or dentist inspects the gums, teeth, and palate to see the width and depth of the alveolar cleft, whether it communicates with the nose, and what teeth are present or missing, forming the basis of the treatment plan.

4. Speech and resonance assessment by a speech therapist – A speech-language pathologist listens to the child’s speech, checking for hypernasality, nasal air escape, articulation errors, and compensatory speech patterns, and may use simple tasks like counting or repeating syllables to assess function.

5. Clinical feeding and swallowing assessment – In infants, a specialist observes feeding, noting how the baby sucks, swallows, and breathes, and looks for nasal regurgitation or choking episodes, which guides advice about special bottles, feeding positions, or early interventions.

Manual tests in the mouth and face

6. Palpation of maxillary segments and alveolar ridge – The surgeon or orthodontist uses gloved fingers to feel the edges of the cleft, the mobility of the maxillary segments, and the quality of the gingiva (gum tissue), information that helps in deciding surgical approaches and orthodontic expansion.

7. Occlusion and bite relationship assessment – Using visual inspection and manual guidance of the jaw, the clinician checks how the upper and lower teeth (or gums in babies) meet, identifying crossbite, open bite, or other malocclusions that will need orthodontic correction.

8. Dental mobility and tooth eruption evaluation – With a dental probe and gentle pressure, the dentist checks how firmly teeth are anchored and whether erupting teeth are following a normal path or are erupting into the cleft area, which influences the timing of bone grafting.

9. Nasal airflow and patency tests at the bedside – Simple bedside tests, such as holding a cold mirror under the nostrils to see condensation on breathing, help to assess whether nasal blockage or deformity associated with the cleft is affecting airflow.

Lab and pathological tests

10. Complete blood count and basic pre-operative labs – Before major surgeries such as alveolar bone grafting, routine blood tests, including hemoglobin, white cells, platelets, and basic biochemistry, ensure that the child is fit for anesthesia and not anemic or infected.

11. Coagulation profile – Tests such as PT, aPTT, and INR are checked in children with a history of bleeding problems or when major surgery is planned, to reduce the risk of excessive bleeding during bone grafting or other procedures.

12. Genetic testing and counseling – In children with other anomalies or a strong family history, genetic tests may be done to look for specific syndromes or gene variants, and the results are used to give parents counselling about recurrence risk in future pregnancies.

13. Microbiological cultures from nasal or oral discharge – If there is persistent infected discharge from an oronasal fistula or around the cleft area, swabs may be taken for culture and sensitivity to guide antibiotic choice before or after surgery.

14. Histopathological examination of abnormal tissue – If any unusual tissue, such as a mass or suspicious lesion, is found in the cleft region or graft site, it may be biopsied and examined under the microscope to rule out rare tumors or chronic inflammatory conditions.

15. Nutritional assessment labs (for example, serum albumin) – In undernourished children, tests such as serum albumin and other nutritional markers help to decide whether nutritional support is needed before major cleft surgeries to improve wound healing and graft success.

Electrodiagnostic tests

16. Electrocardiogram (ECG) for anesthesia assessment – An ECG is often done before surgery to check heart rhythm and detect hidden heart problems, especially in children with syndromes where both heart and facial anomalies may occur together.

17. Auditory brainstem response (ABR) or similar hearing tests – ABR uses small electrodes and earphones to measure how the hearing nerve and brainstem respond to sound. This is useful in infants with clefts, who have a higher risk of hearing loss due to middle ear fluid and should have their hearing checked early.

18. Polysomnography (sleep study) when sleep-disordered breathing is suspected – In some children with severe maxillary deformity and airway problems, an overnight sleep study records breathing, oxygen levels, heart rate, and brain waves to detect obstructive sleep apnea and guide treatment.

Imaging tests

19. Panoramic dental radiograph (orthopantomogram) – A panoramic X-ray shows all the teeth, upper and lower jaws in one image. It helps to see which teeth are missing, which are impacted, and how close roots are to the cleft, essential information before bone grafting and orthodontic treatment.

20. Cone-beam CT (CBCT) or CT scan of the maxilla and alveolus – CBCT and CT give three-dimensional images of the alveolar cleft, showing its exact size, volume, and relation to teeth and nasal floor. These scans are now widely used to plan alveolar bone grafting, to calculate the volume of bone needed, and later to evaluate how well the graft has taken.

Non-pharmacological treatments (therapies and other supports)

1. Multidisciplinary cleft team care
A cleft team (surgeon, orthodontist, pediatrician, speech therapist, dentist, psychologist, nutritionist) plans all steps of care from infancy to adulthood. Team care makes sure feeding, growth, teeth, speech, hearing and appearance are treated in a coordinated way, not as separate problems. [1]

2. Parental and genetic counselling
Parents receive simple explanations about the cleft, expected treatments, and chances of clefts in future pregnancies. Genetic counselling helps families understand that most clefts are multifactorial (genes + environment) and explains realistic recurrence risks, which reduces guilt and anxiety. [2]

3. Special feeding techniques and cleft bottles
Babies with an alveolar cleft and/or cleft palate may struggle to create suction. Special soft bottles, squeezable nipples and careful upright positioning help milk flow into the mouth without entering the nose or airway, improving weight gain and reducing the risk of aspiration. [3]

4. Lactation and nutrition counselling
Dietitians and lactation consultants teach parents how to combine breast milk with cleft-friendly feeding devices, increase calorie density and monitor weight. Good early nutrition improves immunity, wound healing and readiness for future surgeries such as bone grafting. [4]

5. Nasoalveolar molding (NAM) and pre-surgical orthopedics
NAM is a device that gently pushes the gum segments and nose cartilage into a better position before surgery. By slowly guiding the jaw and nose, surgeons can achieve a smaller cleft gap, better nasal shape and easier later grafting with less scarring. [5]

6. Maxillary expansion with orthodontic appliances
In older children, expanders and braces widen a narrow upper jaw before or after bone grafting. Expansion improves arch form, creates space for permanent teeth to erupt through the graft and helps the surgeon place bone in a more stable position. [6]

7. Regular dental care and fluoride programmes
Children with clefts often have crowded, rotated, missing or extra teeth, which makes brushing difficult. Early dental visits, fluoride varnish, sealants and careful hygiene instructions reduce tooth decay and gum disease around the grafted area and protect long-term dental health. [7]

8. Oral hygiene training around the cleft and graft
Simple brushing techniques, small-head brushes and sometimes special interdental brushes are taught before and after surgery. Clean gums lower infection risk after bone grafting and help the graft integrate with the existing bone. [8]

9. Speech and language therapy
If air escapes through the nose or teeth are poorly positioned, a child may have nasal speech or unclear consonants. Speech therapists use games and repetition exercises to train correct tongue and lip positions and reduce hypernasality once the cleft and fistulae are closed. [9]

10. Orofacial myofunctional therapy
Simple exercises for lips, cheeks and tongue can improve muscle tone, swallowing patterns and lip seal. Better muscle coordination supports orthodontic stability and may reduce open-mouth posture that can worsen jaw growth imbalance. [10]

11. Psychological counselling and family support
Visible facial differences, repeated hospital visits and speech problems can affect self-esteem. Counselling, play therapy and peer support groups help children and parents cope with stress, teasing at school and body-image concerns. [11]

12. Early developmental stimulation programmes
Some children with clefts also have syndromes or hearing problems. Simple home-based play, reading, and early intervention services support language, motor skills and social development so the child does not fall behind peers. [12]

13. Hearing assessment and ear care
Cleft palate often causes fluid build-up in the middle ear and hearing loss. Regular hearing tests and ear tube placement (grommets) when needed help the child hear clearly, which is essential for normal speech development and school performance. [13]

14. School counselling and learning support
Teachers may need simple education about the child’s condition, surgeries and speech issues. Classroom seating near the teacher, extra time for oral presentations and anti-bullying programmes help the child feel included and confident. [14]

15. Social work and financial counselling
Social workers connect families to government schemes, charity funds and transport support so they can attend all needed surgeries and check-ups. This reduces dropout from long treatment plans and improves final outcomes. [15]

16. Lifestyle advice for household smoke and pollution
Parents are advised not to smoke near the child and to reduce indoor pollution. Clean air lowers the risk of respiratory infections, which can delay planned surgeries and increase complications after anesthesia and bone grafting. [16]

17. Pre- and postoperative breathing and coughing exercises
Simple deep-breathing and gentle coughing exercises, taught by nurses or physiotherapists, help clear secretions after anesthesia and reduce chest infections, especially when long bone-graft surgeries are needed. [17]

18. Pain-coping education
Children and caregivers are taught how to use cold packs, distraction, relaxation and positioning to ease discomfort after surgery, alongside medicines. Good non-drug pain control can reduce anxiety and make recovery smoother. [18]

19. Long-term follow-up in cleft clinics
Regular follow-up allows the team to monitor jaw growth, tooth eruption through the graft, speech, nasal airflow and self-esteem. Problems such as graft resorption, tooth impaction or fistula recurrence can then be treated early. [19]

20. Preconception counselling for future pregnancies
For families planning another child, clinicians discuss folic-acid use, multi-vitamins, avoidance of smoking and alcohol, and control of chronic diseases. This may modestly reduce the risk of recurrence of cleft conditions. [20]

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Drug treatments

Important: Drug choices and doses must be decided by the child’s surgeon or pediatrician. The examples below explain typical roles, not personal medical prescriptions.

1. Ibuprofen oral suspension
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for mild to moderate pain and fever in children after cleft and bone-graft surgery. Typical pediatric doses are around 10 mg/kg every 6–8 hours, up to a daily maximum, as directed by the doctor. It works by blocking cyclo-oxygenase enzymes and reducing prostaglandins, which lowers pain and inflammation. Main side effects include stomach upset, bleeding risk and kidney stress, so it must be used for limited days under supervision. [1]

2. Acetaminophen (paracetamol) oral liquid
Acetaminophen is commonly used alongside or instead of ibuprofen for post-operative pain and fever. It acts mainly in the central nervous system to raise the pain threshold and lower fever. Doctors calculate the dose by weight and keep within a safe daily maximum to protect the liver. When used correctly, it has a gentle stomach profile compared with NSAIDs, but overdose can cause serious liver injury. [2]

3. Amoxicillin oral suspension
Amoxicillin is a penicillin-class antibiotic used to treat or prevent infections of the ear, nose, throat and respiratory tract, which are common around cleft surgery periods. The label describes use in children with weight-based doses divided two or three times daily. It kills susceptible bacteria by blocking cell-wall synthesis. Common side effects include rash, diarrhea, nausea and, rarely, allergic reactions. [3]

4. Amoxicillin–clavulanate (AUGMENTIN ES)
This combination adds clavulanate, which blocks many beta-lactamases, widening the spectrum against resistant organisms in sinus, ear or chest infections that can complicate cleft care. Pediatric doses are calculated per kg and given with food to reduce stomach upset. Side effects include diarrhea, liver enzyme changes and allergic reactions, so doctors use it only when clearly needed. [4]

5. Cefazolin injection (perioperative prophylaxis)
Cefazolin, a first-generation cephalosporin, is frequently used intravenously as perioperative prophylaxis in clean-contaminated head and neck surgeries, including cleft and bone-graft procedures, to lower surgical-site infection risk. It works by inhibiting bacterial cell-wall synthesis. Dosing is adjusted for age, weight and kidney function. Allergic reactions, diarrhea and, rarely, seizures in overdose are noted in labeling. [5]

6. Chlorhexidine 0.12% oral rinse (PERIDEX / PERIOGARD)
In older cooperative patients, chlorhexidine mouthwash may be prescribed short-term after grafting to reduce plaque and gingivitis around the surgical site. It is an antiseptic that binds to oral surfaces and disrupts bacterial membranes. Patients rinse and spit; it should not be swallowed. Side effects include temporary staining of teeth and altered taste; long-term continuous use is avoided. [6]

7. Topical chlorhexidine swabs or gels
For younger patients unable to rinse, chlorhexidine gels or swabs may be gently applied by clinicians to keep the wound margins clean. The mechanism is the same – broad antimicrobial action on dental plaque and oral bacteria – to support graft healing while brushing is limited. Irritation or allergy is possible, so use is carefully monitored. [7]

8. Ondansetron (anti-nausea medicine)
Ondansetron is a 5-HT₃ receptor blocker used to prevent nausea and vomiting after anesthesia or opioid use in cleft surgery. Better nausea control helps the child drink fluids, eat soft food and take oral medicines, which protects hydration and healing. Doses are weight-based; side effects may include headache, constipation and rare heart-rhythm changes. [8]

9. Short-course systemic corticosteroids (e.g., dexamethasone)
In some protocols, a single perioperative dose of dexamethasone is used to reduce post-operative swelling, nausea and pain. Corticosteroids bind nuclear receptors, decreasing inflammatory mediators. Because of effects on immunity and blood sugar, they are usually given only as brief courses under specialist guidance. [9]

10. Local anesthetics with vasoconstrictor (e.g., lidocaine with epinephrine)
Surgeons inject local anesthetics around the cleft and donor sites to provide pain control during and immediately after surgery. Lidocaine blocks sodium channels in nerves; epinephrine shrinks blood vessels, reducing bleeding and prolonging numbness. Toxicity can cause seizures or heart rhythm issues, so doses are carefully calculated by weight. [10]

11. Opioid rescue analgesics (e.g., morphine or oxycodone)
For severe post-surgical pain, small, carefully monitored doses of opioids may be used in hospital. They bind μ-opioid receptors to change pain perception. Because of risks of respiratory depression, constipation and dependence, cleft teams now try to minimize opioids and combine them with NSAIDs and acetaminophen. [11]

12. Saline nasal sprays or drops
Isotonic saline sprays can gently clear crusts and secretions from the nose, especially after surgeries that involve the nasal floor. Better nasal hygiene reduces obstruction, improves breathing and lowers infection risk. Side effects are minimal when used correctly. [12]

13. Topical nasal decongestants (short-term only)
Very short courses of decongestant drops or sprays may be used by specialists after nasal surgery to reduce swelling and improve airflow. They constrict blood vessels in the nasal mucosa. Overuse can cause rebound congestion and mucosal damage, so instructions are strict and time-limited. [13]

14. Iron supplements when needed
Children with repeated surgeries and low dietary intake may develop anemia. Iron supplements help rebuild hemoglobin and support oxygen delivery to healing tissues. They work by supplying elemental iron for red-blood-cell production. Common side effects are stomach upset and dark stools; overdoses are dangerous, so child-proof storage is essential. [14]

15. Vitamin D drops or tablets
Vitamin D is sometimes supplemented in deficient children to support bone mineralization before or after bone grafting. It helps calcium absorption and bone turnover. Doses are based on age and blood levels; long-term excessive doses can cause high calcium and kidney problems, so medical monitoring is required. [15]

16. Antibiotic ear drops (if ear tubes are present)
Children with clefts often have ear tubes for middle-ear disease. When infections occur, antibiotic ear drops are used rather than systemic antibiotics, targeting bacteria directly in the ear canal and middle ear. Side effects are usually mild, but the exact choice depends on local resistance patterns and age. [16]

17. Nasal saline–bicarbonate rinses (specialist protocols)
Some centers use gentle buffered saline rinses after palatal or alveolar surgery to keep the nose and surgical area moist and clean. The solution mechanically flushes mucus and reduces crust formation, supporting comfort and wound healing. These are used only when the surgeon feels they are safe for that particular repair. [17]

18. Topical antibiotic ointments at skin incision sites
Where lip or external skin incisions are present, a thin layer of topical antibiotic ointment may be used briefly to lower superficial infection risk. It acts locally on skin bacteria. Prolonged or unnecessary use can encourage resistance or contact allergy, so surgeons limit the duration. [18]

19. Mouth moisturising gels or sprays
After surgery, children may breathe through the mouth more than usual, causing dryness. Neutral, non-medicated gels or sprays keep tissues moist and reduce discomfort. This indirectly helps children maintain oral intake and hygiene. [19]

20. Probiotic preparations (research/adjunct only)
Some clinicians are exploring probiotics to support gut microbiota during and after repeated antibiotic courses. The idea is to reduce antibiotic-associated diarrhea and improve general gut health. Evidence is evolving, and products vary, so families should only use such supplements after discussing them with their pediatrician. [20]

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Dietary molecular supplements

Always discuss supplements with the child’s doctor, especially in pregnancy and early childhood.

1. Folic acid
Folic acid (vitamin B9) is strongly recommended for people who could become pregnant to prevent neural tube defects and may modestly reduce the risk of orofacial clefts in some studies. Typical pre-pregnancy and early-pregnancy doses are 400–800 µg/day, or higher in high-risk women, as advised by guidelines. It supports DNA synthesis and cell division in rapidly growing fetal tissues. [1]

2. Prenatal multivitamin with folate
A balanced prenatal multivitamin usually contains folic acid, iron, iodine, vitamin D and other micronutrients. When started before conception and continued through early pregnancy, it can support normal fetal growth and may lower the risk of some birth defects, including oral clefts in some populations. Dose and brand should be chosen with an obstetric provider. [2]

3. Vitamin D supplement
Vitamin D (often 400–1000 IU/day in children depending on age and local policy) helps calcium absorption and bone mineralization. Adequate levels before alveolar bone grafting may support stronger bone healing and overall skeletal health. Excessive doses are avoided to prevent high calcium and kidney damage. [3]

4. Calcium
Dietary or supplemental calcium works with vitamin D to build mineralized bone. In children with low intake of dairy or fortified foods, carefully dosed supplements can help maintain adequate daily calcium for normal jaw and tooth development and graft integration. Very high doses are avoided to prevent kidney stones. [4]

5. Iron
If blood tests show iron-deficiency anemia, iron supplements support red-blood-cell production. Better hemoglobin improves oxygen delivery to the alveolar graft and other healing tissues. Doses are weight-based; taking iron with vitamin C-rich foods can improve absorption but may irritate the stomach. [5]

6. Vitamin C
Vitamin C is a key co-factor for collagen synthesis and wound healing. Adequate dietary intake from fruits and vegetables, or small supplements when needed, can support soft-tissue repair around the cleft. Very high doses can cause stomach upset and are usually unnecessary with a balanced diet. [6]

7. Zinc
Zinc is essential for immune function and tissue repair. In children with documented deficiency or poor diets, supervised zinc supplementation may help support normal growth and wound healing after cleft surgeries. Too much zinc can interfere with copper balance, so doses must follow medical advice. [7]

8. Omega-3 fatty acids
Omega-3 fats from fish oil or algae may support general health and have mild anti-inflammatory effects. In appropriate doses they may gently support healing and cardiovascular health, but they can increase bleeding tendency at high doses, so surgeons often pause them around major surgery. [8]

9. Protein or amino-acid supplements
In undernourished children who cannot meet needs with food alone, high-protein oral supplements may be used to reach adequate daily protein for growth and post-operative repair. Protein supplies amino acids for collagen and bone matrix in the graft area. Supplements must be tailored by a dietitian to avoid excess calories. [9]

10. Iodine-containing supplements (within prenatal vitamins)
Iodine supports normal thyroid function and brain development in the fetus and growing child. Many prenatal vitamins now include iodine in recommended amounts. Maintaining normal thyroid status supports growth, metabolism and overall recovery after surgeries. Excess iodine or unsupervised high-dose use can disturb thyroid function, so medical guidance is essential. [10]

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Drugs for immunity support / regenerative or stem-cell–related use

1. Routine childhood vaccines (e.g., DTP, MMR, pneumococcal, influenza)
Vaccines are not specific to alveolar cleft, but they protect children from serious infections that could complicate surgeries or slow healing. By training the immune system to recognise germs without causing disease, vaccines reduce hospitalizations and keep children strong enough to proceed with planned cleft operations. [1]

2. Vitamin D (immune-modulating role)
Besides bone effects, vitamin D influences immune cell function. Maintaining normal levels through safe sunlight exposure, diet and prescribed supplements can lower the risk of respiratory infections and support general immune resilience around surgical times. It is not an “instant booster” but part of long-term health. [2]

3. Recombinant human bone morphogenetic protein-2 (rhBMP-2) – INFUSE Bone Graft
rhBMP-2 is a lab-made protein placed on a collagen sponge to stimulate new bone formation at surgical sites. Some oral and maxillofacial surgeons use rhBMP-2 in selected alveolar cleft reconstructions, often in research or specialized centers, as an alternative or complement to traditional bone grafts. It induces local osteogenesis but carries specific risks, so use is highly regulated. [3]

4. Platelet-rich fibrin / platelet-rich plasma (biologic adjuncts)
Although not classical “drugs”, platelet-based preparations are used in some centers to enhance healing at graft sites. Concentrated platelets release growth factors that can support blood vessel formation and tissue repair in the alveolar cleft area. These are prepared from the patient’s own blood and used only in controlled surgical settings. [4]

5. Experimental cell-based bone-marrow–derived therapies
Research groups are studying mesenchymal stem cells combined with scaffolds to regenerate bone in cleft defects. These cells can differentiate into bone-forming cells and may one day reduce the need for large bone harvests. At present, such treatments remain experimental and are used in clinical trials, not routine practice. [5]

6. Nutritional and metabolic optimisation as “immune-regenerative” support
Correcting anemia, vitamin D deficiency, malnutrition and chronic infections before surgery acts like a whole-body regenerative strategy. By improving oxygen delivery, bone metabolism and immune responses, this careful medical optimisation can significantly improve bone-graft success and recovery, even though it uses standard approved drugs and supplements rather than a single “miracle” agent. [6]

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Key surgeries for alveolar cleft

1. Alveolar bone grafting (secondary alveolar bone graft, SABG)
This is the core operation for the cleft in the alveolar process. Bone (often from the hip) or bone substitute is placed into the gap in the upper gum, usually between 6–11 years of age, before eruption of the permanent canine. It unifies the maxillary arch, closes oral–nasal fistulae and provides bone support for teeth and future implants. [1]

2. Primary or early secondary alveolar bone grafting
In some centers, grafting is done earlier (during or soon after primary lip repair, or between 4–6 years) to support early tooth development and reduce collapse of the segments. The timing choice balances benefits for dental eruption with potential effects on facial growth, so each cleft team follows its own evidence-based protocol. [2]

3. Cleft lip repair (cheiloplasty)
Lip repair is often done in infancy and may be combined with nasal corrections. While it mainly targets appearance and lip seal, a well-done repair can improve feeding, reduce nasal leakage and indirectly improve positioning of the alveolar segments in preparation for later bone grafting. [3]

4. Palatoplasty and fistula closure
Closing the cleft palate and any residual fistulae between mouth and nose improves speech and reduces regurgitation of food. A stable, well-healed palate and nasal floor provide a clean and enclosed environment for later alveolar bone grafting and reduce the risk of graft contamination from nasal leakage. [4]

5. Orthognathic surgery and implant-supported prosthetics (in adolescence/adulthood)
If the upper jaw remains retruded or asymmetrical despite earlier care, jaw surgery (orthognathic procedures) in the late teens can reposition the maxilla and mandible for better bite and facial balance. After growth is complete, dental implants or bridges may be placed into the grafted alveolar bone to replace missing teeth and restore full dental function. [5]

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Prevention and risk-reduction points

Because clefts are multifactorial, we cannot prevent all cases, but some steps may reduce risk or improve outcomes.

1. Pre-pregnancy folic-acid supplementation – Taking 400–800 µg folic acid daily before conception and in early pregnancy is strongly recommended for neural tube defect prevention and may lower risk of some oral clefts. [1]

2. Use of prenatal multivitamins – A balanced prenatal multivitamin that includes folic acid appears in several studies to reduce the risk of orofacial clefts compared with no supplementation, though the effect size varies. [2]

3. Avoidance of smoking and second-hand smoke in pregnancy – Smoking is linked with a higher risk of orofacial clefts and many other complications, so stopping smoking and avoiding smoke exposure is important. [3]

4. Limiting alcohol and certain drugs in pregnancy – Heavy drinking and some medicines (for example, certain anti-seizure drugs) are associated with higher rates of facial birth defects, so women should review all medicines with their obstetric provider before conception when possible. [4]

5. Good control of maternal illnesses (e.g., diabetes, obesity) – Managing chronic conditions before and during pregnancy helps reduce congenital anomalies and improves fetal growth. [5]

6. Healthy, varied diet rich in natural folate – Eating leafy greens, beans, citrus fruits and fortified grains provides natural folate and other vitamins that support normal fetal development. [6]

7. Early, regular antenatal care – Early pregnancy visits allow screening for risk factors, counselling about supplements and early ultrasound to detect anomalies, which helps families and teams plan care. [7]

8. Vaccination of the mother – Vaccines against certain infections (such as rubella, where relevant) can prevent illnesses that might otherwise affect fetal development. [8]

9. Avoidance of self-medication in pregnancy – Many medicines and herbal products have not been tested in pregnancy. Using only doctor-approved drugs reduces unknown teratogenic risks. [9]

10. Family planning and spacing of pregnancies – Allowing time between pregnancies lets the mother rebuild nutrient stores, including folate and iron, which supports healthier future pregnancies. [10]

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When to see doctors

Parents should seek medical or specialist cleft-team advice immediately after birth if the baby has any visible cleft of lip, palate or gum. Early referral allows feeding support, hearing checks and planning of surgeries in a proper sequence. [1]

Children with a known alveolar cleft should see the cleft team promptly if there is poor weight gain, frequent ear or chest infections, nasal regurgitation of food, very unclear speech, or visible swelling, pain or discharge from the gum or nose, which may suggest infection of the cleft or graft. They should also attend all scheduled reviews around the time of mixed dentition to time the alveolar bone graft correctly. [2]

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Simple diet tips – what to eat and what to avoid

1. Soft, high-protein foods after surgery – Yogurt, soft eggs, well-cooked lentils, mashed potatoes and smoothies are gentle on the repaired area and provide protein for healing. [1]

2. Plenty of fluids – Water, oral rehydration solutions and thin soups prevent dehydration when chewing is painful. [2]

3. Fruits and vegetables in soft form – Mashed banana, pureed vegetables and soft fruits give vitamins and fiber without hard chewing. [3]

4. Iron-rich foods – Soft cooked beans, lentils, eggs and, when culturally suitable, soft meats help prevent anemia and support healing. [4]

5. Foods rich in natural folate – Spinach, peas, beans and fortified cereals are good folate sources for women of childbearing age. [5]

6. Avoid hard, sharp or crunchy foods after surgery – Chips, nuts, crusty bread and raw carrots can injure the surgical site or graft and should be avoided until the surgeon says chewing is safe. [6]

7. Limit very hot foods and drinks initially – Very hot items can increase pain and may disturb early clots and sutures; lukewarm or cool foods are safer right after surgery. [7]

8. Avoid sugary snacks and drinks – High-sugar juices, sweets and sodas increase risk of tooth decay around the graft area, especially when brushing is difficult. [8]

9. Be cautious with straws and sucking – For a period after many cleft surgeries, strong suction is discouraged, so children may be advised not to drink through straws until healing is secure. [9]

10. Follow the cleft team’s written diet plan – Every surgery type and age group has specific diet instructions; following the written plan from the surgeon and dietitian is the safest way to support healing. [10]

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Frequently asked questions (FAQs)

1. Is an alveolar cleft just a cosmetic problem of the gum?
No. An alveolar cleft affects bone, gum and tooth positions. It can cause problems with tooth eruption, arch stability, speech, nasal leakage and long-term dental health, so proper reconstruction is important for both function and appearance. [1]

2. At what age is alveolar bone grafting usually done?
Many teams perform secondary alveolar bone grafting in the mixed dentition stage, often between about 6 and 11 years, just before eruption of the permanent canine near the cleft. Exact timing depends on tooth development and local protocols. [2]

3. Where does the graft bone usually come from?
The hip (iliac crest) is a common donor site because it provides spongy bone rich in marrow cells that integrate well into the cleft. Some centers use mandibular bone or bone substitutes and growth factors in selected cases. [3]

4. Will my child always need traditional bone grafts, or can rhBMP-2 replace them?
rhBMP-2 can stimulate bone formation and has been studied in alveolar cleft repair, but it does not fully replace traditional grafts in all patients. Use depends on center experience, cost, regulatory approvals and individual risk–benefit decisions. [4]

5. Can teeth erupt through the grafted bone?
Yes. One of the main goals of alveolar bone grafting is to provide bone so that permanent teeth next to the cleft can erupt into a stable, bony ridge, which improves chewing and allows later orthodontic alignment. [5]

6. What happens if the bone graft fails or resorbs?
Sometimes grafted bone resorbs or does not fully integrate, especially with infection, poor oral hygiene or heavy functional stress too early. In such cases, the team may plan a repeat graft or alternative restorative and orthodontic solutions. [6]

7. Will my child always have visible facial differences after treatment?
Modern cleft care aims for both functional and cosmetic improvement. While some scars and minor asymmetries often remain, many children achieve very natural facial appearance and confident smiles after staged repairs, orthodontics and, if needed, later jaw surgery. [7]

8. Does an alveolar cleft affect brain development?
The cleft involves bone and soft tissues of the face and mouth, not the brain. Children with isolated clefts usually have normal intelligence. However, hearing problems, speech delays or associated syndromes can affect learning, so early support is important. [8]

9. Is breastfeeding possible with a cleft of the alveolus and palate?
Direct breastfeeding can be difficult if suction is poor, but some babies manage partial breastfeeding with special positions. Pumped breast milk given via special cleft bottles is often used to combine immune benefits of breast milk with safer feeding mechanics. [9]

10. Will my child need braces even after bone grafting?
Most children with alveolar clefts need orthodontic treatment to align crowded or rotated teeth and to coordinate the upper and lower jaws. Bone grafting provides the foundation, but braces are typically required to finish the dental alignment. [10]

11. How long is the recovery after alveolar bone grafting?
Hospital stay is often a few days, with several weeks of soft diet and activity restrictions. Swelling and discomfort decrease over about 1–2 weeks, but full bone healing and integration take months, so orthodontic loading is usually delayed for at least 6 months. [11]

12. Can adults with untreated alveolar clefts still be treated?
Yes. Adults can undergo secondary or tertiary grafting, orthodontics and prosthetic rehabilitation. Results may be more complex because growth is complete and teeth may be missing or malpositioned, but many adults still benefit greatly from late reconstruction. [12]

13. Does having one child with a cleft mean all future children will have clefts?
No. The recurrence risk is higher than in the general population but still relatively low for most families. Genetic counselling can estimate risk based on family history and suggest folic-acid supplementation and other risk-reduction strategies. [13]

14. Are there activities or sports my child should avoid long-term?
After full healing, most children can participate in normal play and sports. During the immediate post-operative period, rough play and contact sports are restricted to protect the graft and surgical sites, but long-term physical activity is encouraged for overall health. [14]

15. Where should families look for reliable information and support?
The best first source is the local multidisciplinary cleft team and their written materials. In addition, reputable cleft charities, national cleft organisations and government-backed health sites provide trustworthy information and parent stories, helping families feel less alone on the treatment journey. [15]

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: January 28, 2025.