Isolated Paramedian Lower Lip Cleft: A Case of a Rare Form of a 28–29 Tessier Cleft

An isolated paramedian lower lip cleft is an extremely rare congenital anomaly classified within Tessier clefts 28-29. The embryological basis remains incompletely understood, and very few cases have been documented. We report the third isolated case and sixth overall of a paramedian lower lip cleft in a 43-year-old male. Clinical examination revealed a full-thickness cleft of the lower lip on the left side, just lateral to the midline. It presented as a discontinuity of the red line, the vermilion, and the white roll. Surgical repair was performed using a Z-shaped incision on the clefted side and an inverted L-shaped incision on the contralateral side to restore symmetry and function. Postoperative recovery was uneventful, and the patient achieved competent lip function with a satisfactory esthetic outcome. This case highlights a rare variant of Tessier cleft and underscores the importance of documenting such anomalies, expands the clinical spectrum of Tessier clefts 28-29, guides surgical decision-making, builds a more comprehensive understanding, improves outcomes for future patients, and improves awareness among clinicians encountering similar presentations.