This particular case is of a 23 year old man with a rare complex congenital cranio-facial cleft involving the maxilla (upper jaw), nose (including the bony nasal cavity) and nasal septum, upper lip and both orbits (eye sockets).

The abnormal anatomy is difficult to understand by a physical examination as there is gross absence, displacement or hypoplasia (stunted growth) of a variety of tissues in a 3dimensional field, especially the central third of the face (nose and nasal cavity). The anomalies of the skeleton are important to understand pre-operatively as pre-surgical planing will be of paramount importance in this case. The smallest surprise faced suddenly at the time of operation could be the difference between success and failure; between correction of this ghastly disfigurement and its continuance.