Oblique facial clefts: a report of Tessier numbers 3, 4, 5, and 9 clefts.

The oblique facial cleft is an extremely rare and disfiguring congenital anomaly of the face. Tessier (1990) proposed an anatomic classification of the facial, craniofacial, and laterofacial clefts that was a great advance in the study of these clefts. The clefts were found to occur with an incidence of 1.43 to 4.85 in 100,000 births (Kawamoto, 1976). The exact incidence of these unusual facial clefts is unknown, and estimates vary widely because of the rarity of their occurrence and the lack of standard methods of data collection. To adequately examine the occurrence of oblique clefts, the medical community must be aware of the problem, and new cases should be presented. On the basis of clinical, radiologic, and surgical examinations, soft tissue and skeletal disruptions of three patients with the most rare craniofacial clefts (Tessier 3, 4, 5, and 9) are presented.