The authors report a cystic lesion within a previous unilateral cleft lip and alveolus bone graft site in a 15-year-old girl, 5 years after the secondary bone graft. The cyst comprised respiratory epithelial lining, which is thought to be a remnant of the nasal mucosal lining of the primary cleft.
Alveolar bone grafting is an established method of reconstructing the alveolar cleft. Complications at the cleft site include bleeding, pain, wound breakdown, low-grade infection, bone sequestration, bone loss, bone resorption, residual fistulae, loss of vestibular depth and gingival hyperplasia, injury to adjacent teeth, and external bone resorption. The authors present an unusual case of cyst formation within a previously grafted cleft alveolus.
A 15-year-old Afro-Caribbean girl with right-sided unilateral cleft lip and alveolus had a secondary bone graft in the cleft area with iliac crest cancellous bone graft at the age of 10 years. An upper occlusal radiograph taken 2 months postoperatively demonstrated good bony infill ( Fig. 1 ).
The patient remained under regular multidisciplinary cleft team review. A repeat upper occlusal radiograph of the area was taken 5 years later prior to planned orthodontic treatment ( Fig. 2 ). This showed a radioluscency within the alveolus. The patient was asymptomatic.
Repeat alveolar bone grafting was planned for presumed graft loss due to bone resorption. At the time of surgery, a well formed cyst was noted ( Fig. 3 ) measuring approximately 1.5 cm in diameter. The cyst was removed intact and the residual defect was re-grafted with cancellous iliac crest bone.
The histology of the cyst showed cyst wall composed of fibrous and granulation tissue containing lobules of minor secretary glands. The high power image ( Fig. 4 ) shows the cyst wall containing mucous glands and goblet cells within the epithelium, consistent with a sinonasal type epithelium. This confirms it is a benign inclusion cyst of respiratory epithelial type.