Facial dermoids are uncommon. We present the first case of a nasomaxillary dermoid since Bramann's original 1890 description. A dermoid sinus in this location further supports Bland-Sutton's hypothesis of ectodermal sequestration between embryologic facial prominences. Contralateral cleft lip and palate in our patient suggest a common pathogenesis involving abnormal formation of the maxillary prominences and failure of fusion and merging.