Ectopic Rib Cartilage and an Undisclosed Silicone Implant: An Unexpected Discovery During Secondary Cleft Lip Revision

This case report describes an unexpected intraoperative discovery during secondary revision surgery for residual unilateral cleft lip deformity in an 18-year-old female. Despite a consistent patient history of a prior "autologous costal cartilage rhinoplasty," surgical exploration revealed an undocumented silicone dorsal nasal implant and ectopic costal cartilage within the alveolar cleft defect, the first known report of such concomitant findings. The ectopic cartilage, representing a biologically unsound approach to alveolar reconstruction, was excised entirely to establish a viable bony recipient bed. Subsequent alveolar reconstruction was performed using β-tricalcium phosphate (β-TCP), which was selected based on its proven osteoconductive properties and to minimize donor-site morbidity. The surgical plan also included nasolabial correction and adjustment of the nasal silicone implant. The patient recovered uneventfully with significant aesthetic improvement. This case underscores the limitations of preoperative imaging and historical documentation in revision surgery, highlighting the necessity for intraoperative vigilance. Furthermore, it raises profound ethical concerns regarding medical transparency and informed consent, advocating for the enhanced preoperative identification of existing implants and transparent communication between surgeons and patients.