# Unusual Bilateral Oblique Craniofacial Cleft with Atypical Cleft of Palate: A Case Report with 3 Years of Follow-Up

## TL;DR

A rare case of unusual facial and palate clefts in a child is reported, with surgical treatments and a 3-year follow-up showing successful outcomes.

## Contribution

This case report presents a unique combination of bilateral oblique craniofacial clefts and atypical palate cleft with long-term surgical follow-up.

## Key findings

- The child had a rare combination of bilateral medial and lateral oro-ocular clefts and a cleft palate with a tongue-like palatal shelf.
- Surgical closure of the clefts in two stages improved function and appearance, with correction of velopharyngeal incompetence and macrostomia.
- The sliding V-Y flap effectively corrected macrostomia and ensured oral competence.

## Abstract

Oblique facial clefts are a rare entity and can be associated with palatal anomalies like synechiae caused by amniotic bands. Their treatment is individualized following sound reconstructive surgical principles. This is a case report of a 15-month-old child with cleft palate in which the right palatal shelf was represented by a tongue-like projection, associated with macrostomia and bilateral medial and lateral oro-ocular clefts. The palatal cleft was closed in two stages and the oblique clefts in the first stage. At 4 years of age, the velopharyngeal incompetence was addressed by a superiorly based pharyngeal flap. The macrostomia was corrected by a sliding V-Y flap, which effectively lengthened the buccal mucosa and ensured oral competence.