Letters to the Editor Prenatal diagnosis of a cleft of the tongue, lower lip and mandible In contrast to cleft lip and palate, which are common 1 , median mandibular clefts are extremely rare 2 and show broad variation in severity. There may be associated anomalies, such as lower lip hemangioma 3 , cleft palate 4 , facial anomalies 5-7 , cervical dermoid cyst, abnormal hyoid bone (fissure or agenesis) 7,8 , malformation of the laryngeal cartilage 9 and aplasia of the epiglottis, cardiac malformation 6,7,9 and chromosomal abnormalities, which can worsen the neonatal prognosis and therefore need to be known before delivery. Anomalies of the pharynx and Figure 1 Prenatal ultrasound assessment of the mandibular cleft at 32 weeks of gestation: (a) two-dimensional (2D) image of the frontal view of the chin showing the cleft of the lip and chin; (b) 2D image of the cross-sectional view of the floor of the mouth showing bifid tongue; and (c) three-dimensional reconstruction of the face showing the cleft of the lip and chin. (d) T2-weighted magnetic resonance image of the frontal section showing bifid tongue at 35 weeks.