Nasolacrimal abnormalities in oblique facial clefts

A patient with a Tessier No. 4 cleft and an associated bifid nasolacrimal system is presented and considered within the Tessier classification of craniofacial clefting. Previous accounts of nasolacrimal abnormalities associated with facial clefts are reviewed together with the accepted developmental embryology. It is proposed that the bifid nasolacrimal duct system described constitutes a new addition to the literature.