Costochondral Graft Rejection or Foreign Body Reaction 55 years after cleft lip revision: Case Report and Review of Literature

Introduction: Management of cleft lip and palate is a complex procedure that requires multiple surgeries and placement of autogenous grafts for the closure of primary defects or to correct any secondary deformities. The use of dermal fillers, fat grafts, and alloplastic materials for lip augmentation have been well established in literature. However, there is no evidence of costochondral grafts being used to enhance lip fullness. Case Presentation: This is a unique case report of a 68-year-old unilateral cleft lip patient who underwent secondary lip revision surgery at the age of 10 years, wherein a cartilaginous graft was obtained from her rib and placed in the upper lip. 55 years later, the patient presented with a tender upper lip swelling. Surgical resection revealed a pale whitish foreign body resembling cartilage. A review of literature was performed for previous reports of costochondral grafts in the oral and maxillofacial region and commonly used materials for secondary lip augmentation in cleft patients. Conclusion: It is important to note here that the unusual placement of the costochondral graft invoked a delayed inflammatory response 55 years later, leading to failure, thus making this case rare and essential to report. This highlights the need for rigorous long-term follow-ups in patients with graft placement after a secondary cleft surgery.