Nonsyndromic Mandibular Symphysis Cleft

Median cleft of lower lip and mandible is a rare congenital anomaly described as cleft number 30 of Tessier’s classification. In minor forms only lower lip cleft is seen. We report the case of a patient with median cleft of lower lip, severe ankyloglossia, cleft of mandibular symphysis, and residual cleft involving on right soft palate and associated with other facial clefts. These deformities were corrected in multiple stage procedure, consisting of release of the tongue from floor of the mouth and lower alveolus and fixation of the mandibular cleft done with right iliac bone graft using stainless steel miniplate. 1. Introduction Orofacial clefts are the most common facial malformations in all populations and ethnic groups. Tessier cleft number 30 is a rare congenital deformity and presents with varying degree of severity from isolated median cleft of the lower lip to cleft of the manubrium sterni involving the mandible, tongue, floor of the mouth, hyoid bone, thyroid cartilage, and strap muscles of the neck; the cleft is frequently associated with ankyloglossia and median web in the neck extending from chin, causing neck contracture [1]. Couronne’ reported the first account of this anomaly in 1819. Since then very few cases have been reported in the literature with different variations. We came across a patient with multiple facial clefts associated with mandibular symphysis cleft and ankyloglossia [2]. 2. Case Report A 28-year-old male patient (Figure 1) reported to our unit with chief compliant of difficulty in speech, disfigurement of face, and difficulty in mastication of food since his childhood. Patient underwent surgery for closure of facial clefts at the age of 1 month under General anaesthesia and at the age of 16 years. On extraoral clinical examination gross facial asymmetry noticed with mandibular midline deviation towards right side, upper, and lower lips was incompetent and previously operated extraoral scars were noticed extending from right side of the corner of mouth, cheek, and auricle and scar on midline of lower lip (Figure 2) and noticed nonoperated clefts on left ear (Figure 3). Figure 1: Frontal view. Figure 2: Right lateral view. Figure 3: Left ear cleft. On intraorally soft tissue examination scar was noticed on right side of the hard palate showing with a residual cleft on right soft palate (Figure 4). On hard tissue examination mandibular symphysis cleft with ankyloglossia (Figure 5) was noticed and on bimanual palpation 2 halves of mandibular segments were freely movable. Midline shift towards right side and crowding in the