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This 7-year-old child was born with a severe bilateral cleft lip and palate deformity. The upper jaw was in three pieces with a completely detached (free floating) premaxillary segment at the centre. There was a fistula on either side of this detached segment, which created a communication between the oral cavity and the nose. Both speech and feeding are affected by this. It is essential that the three pieces of the upper jaw are joined together to ensure normal growth of the jaw and alignment of the teeth. This procedure is done at 7 years old if bone graft is used and at the age of 4 years if recombinant human bone morphogenetic protein (rhBMP-2) is used. Bone graft is harvested from the hip bone (ilium) using a special trapdoor technique. A trapdoor is created on the surface of the cortical bone (hard bone), which is lifted and underlying cancellous bone (soft bone) is scooped out to be used as graft. The trapdoor is then closed, thus ensuring that there is no deformity of the hip bone from the bone harvest surgery. The nasal floor and the oral floor of the fistula on either side of the premaxillary segment is then closed nicely. A pocket is created here, which is packed with the harvested soft hip bone graft to completely fill in the gap between the three separate pieces of the upper jaw. The osteotomized premaxillary segment is then stabilized by fixing it to the adjacent maxillary bone with stainless steel wire. This surgery results in an intact upper jaw, which is now one single bone and enables the patient to have normal growth and good speech. #AlveolarBoneGrafting #CleftLipAndPalate #BilateralCleftSurgery #BoneGraftingForClefts #CleftLipRepair #CraniofacialSurgery #CleftDefectClosure #CleftCare #OralAndMaxillofacialSurgery #BilateralCleftTreatment #AlveolarCleftCorrection #PediatricCleftSurgery #CleftLipDeformity #BilateralCleftReconstruction #DrSMBalaji #CleftSurgeryExpert #FacialReconstruction #CleftLipAwareness #BoneGraftSurgery #SpeechAndFeedingImprovement - For Questions & Queries Balaji Dental, Craniofacial Hospital & Research Institute WhatsApp: +919841007934 | Phone: +91-44-42947222 | +91-44-24326622 63/30, K.B. Dasan Road, Teynampet, Chennai – 600018, INDIA Email: [email protected] Website: https://www.smbalaji.com Blog: http://blog.smbalaji.com Instagram: / drsmbalaji YouTube: / @drsmbalaji Twitter : / balajidental Facebook: / balajidentalindia LinkedIn: / balaji-dental