Atypical facial clefts are rare and result from partial or total non-fusion of embryonal craniofacial tissue. Tessier classified facial clefts and numbered them from 0 to 14, using the orbit as the primary structure of reference. The Tessier three cleft which extends through the upper lip, alar groove, and medial canthus is one of the most destructive of all facial clefts albeit one of the rarest. We report a case of isolated Tessier 3 facial cleft diagnosed on prenatal three-dimensional (3D) ultrasound examination. Two-dimensional sonography revealed a normally growing fetus with an absence of left alae nasi and normal appearing lips, palate, and alveolar ridges. However, a 3D imaging in surface rendering mode showed a large Tessier 3 lateral facial cleft, thus confirming the utility of 3D sonography in the prenatal diagnosis of such rare lateral facial clefts.