Tessier number 4 bilateral orbito-facial cleft: a 26-year follow-up.

Orbito-facial number 4 clefts are the rarest craniofacial clefts and only a few cases have been reported. We report a case of a complete bilateral Tessier number 4 cleft, and our approach to surgical correction. We analyse the patient's treatment plan over a 26-year follow-up period. We comment on the age at which the first surgical procedure is commonly performed with or without a primary bone graft, as well as the use of the facial plasty technique with interdigitating Z-plasty flaps and rotation-transposition flaps. Closure of the cleft can constitute an emergency when the patient's globe is exposed.