Mandibular clefts are extremely rare, with less than 100 cases reported in the literature. Almost universally, these isolated cases of lower facial clefting have been noted to occur through the midline of the lip and/or mandible. The defect can vary, ranging from mild notching of the lower lip or mandibular alveolus to complete mandibular cleavage. The authors present a rare case of a paramedian mandibular cleft in a patient who also had Goldenhar syndrome and Tessier number 2/12 cleft. With its presentation, the authors revisit the Tessier classification of craniofacial clefts and the embryogenesis of lower facial clefts.