Median defect-A Rare congenital anomaly

Median cleft of lower lip and mandible is a rare anomaly. This cleft has also been described as Cleft No. 30 of Tessier's classification. In minor forms only lower lip is affected. Frequently, the cleft extends into the mandibular symphysis and the tongue is attached to the cleft alveolar margin. At times the tongue may be bifid or absent, hyoid absent, thyroid cartilage underdeveloped, strap muscles atrophic, manubrium sterni absent, clavicles widely spaced etc. It may also be accompanied by other congenital anomalies such as a cleft tongue, ankyloglossia, a cardiac lesion, and absence of the hyoid bone. The etiologic is thought to be a failure of mesodermal penetration into the midline structures of the first branchial arch. The earliest report of this anomaly was by Couronne in 1819. Since then very few cases have been reported in literature with variations. Presented here is a case of median cleft of lower lip that was successfully treated and thus was a challenge for reconstruction.