Heterotopic Ossification and Secondary Craniofacial Deformity Following Alveolar Cleft Repair With Costal Cartilage Graft.

BACKGROUND

Autologous costal cartilage grafting represents an alternative to iliac bone in alveolar cleft repair, yet long-term complications such as heterotopic ossification (HO) and secondary craniofacial deformities remain underreported. This case report describes the management of a patient with late-onset HO and secondary nasolabial deformity following costal cartilage grafting.

METHODS

A 23-year-old female presented 8 years after alveolar cleft repair with autologous costal cartilage graft, exhibiting maxillary protrusion, recurrent alveolar cleft, and orbicularis oris dynamic imbalance. The treatment involved a single-stage procedure comprising removal of the ossified graft, Mimics-based digital modeling-guided carving and reimplantation, orbicularis oris sling reconstruction, and alar suspension.

RESULTS

Postoperative evaluation revealed significant improvement in facial symmetry and oral function. Computed tomography confirmed optimal graft adaptation within the alveolar defect. No internal fixation was used, and graft stability was achieved through anatomic interlocking and soft tissue reinforcement.

CONCLUSIONS

Heterotopic ossification should be considered as a potential long-term complication of costal cartilage grafting in alveolar cleft reconstruction. A digitally guided, integrated approach combining graft reimplantation with dynamic soft tissue repair offers an effective strategy for managing such complex secondary deformities, emphasizing the role of biomechanical stability in achieving sustainable outcomes.