Acellular Fish Skin Graft as a Possible Alternative to Autogenous Tissue in Vestibuloplasty for Bilateral Cleft Lip and Palate: A Case Report

Objective: Bilateral cleft lip and palate (BCLP) is a craniofacial malformation often associated with anatomical and functional impairments, including a shallow oral vestibule in the premaxillary region. This condition requires a vestibuloplasty to restore the space between the teeth and upper lip, also improving aesthetics. Traditional techniques frequently require autologous grafts, leading to increased morbidity. Tissue bioengineering provides suitable alternatives. Methods: We present the case of a 19-year-old female, who had undergone several surgeries for BCLP management, complaining of a lack of upper lip projection and an insufficient vestibular dept in the premaxilla region. We reported short-term follow-up using Acellular Fish Skin Graft (AFSG, Kerecis™) as a substitute to autologous graft to perform a vestibuloplasty. Outcome assessment was based on clinical measurements. Results: The graft showed early signs of vascularization. Clinical outcomes included improved vestibular depth, from 1 mm preoperatively to 8 mm, upper lip projection, and functional mobility after a six-month follow-up period. The patient experienced an uneventful recovery and was satisfied with the aesthetic result. Conclusions: This case, presenting the first application of AFSG in vestibuloplasty, tends to reassure us about its safety. AFSG might be an effective biocompatible alternative to autologous grafts in vestibuloplasty, offering promising results in mucogingival reconstruction. Further studies are needed to confirm long-term stability and integration in oral tissues.