I present a review of the pattern of rare craniofacial clefting in patients presenting to a tertiary referral craniofacial unit. Patients with an isolated rare cleft were uncommon; most had multiple axes of disruption. Midline and paramedian facial clefts, although occasionally occurring alone, often overlap with adjacent facial clefts and extend along an upward cranial axis. The corresponding midline and paramedian facial clefts were never seen in isolation but were almost always seen with their axial downward cleft. Lateral nasal, oro-ocular, and lateral forehead clefts showed diffuse and often poorly defined regions of disruption, resulting in a multiplicity in clefts. The small subgroup of patients with features of the amniotic band sequence had more and differently distributed clefts compared with the larger nonamniotic band group.