The Tessier number 5 cleft is a rare craniofacial anomaly. Although there are case reports outlining various methods of primary surgical repair and outcomes, few cases reveal long-term follow-up or discuss secondary reconstruction. This article presents the case of a man born with a unilateral Tessier number 5 cleft who presented to our institution at the age of 41 after more than 25 previous surgeries. Over the course of 11 years, he had several surgeries including an orbital repositioning through a combined intra- and extracranial approach, an orbital enucleation, and an anterolateral thigh flap. The patient was fitted with an orbital prosthesis and a satisfactory aesthetic result was achieved.
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