A New Approach to Classify Cleft Lip and Palate

Abstract

Objective: To propose a new method, which allows for a complete description of primary and secondary cleft palates, incorporating elements that are related to the palate, lip, and nose that will also reflect the complexity of this problem. Method: To describe the type of cleft, two embryonic structures were considered: (1) the primary palate, formed by the prolabium, premaxilla, and columella and (2) the secondary palate, which begins at the incisive foramen and is formed by a horizontal portion of the maxilla, the horizontal portion of the palatine bones, and the soft palate. Anatomical characteristics to be considered were defined, and a new method is proposed to more fully describe any cleft. Results: A description of five cases was made using the method proposed in this work and compared with other published methods for the classification and description of clefts. Conclusions: A mathematical expression was developed to characterize clefts of the primary palate, including the magnitude of palatal segment separation and the added complexity of bilateral clefts, yielding a numerical score that reflects overall complexity of the cleft. Clefts of the secondary palate are also considered in a separate score. Using this method, it is possible to incorporate elements that are not considered in other approaches and to describe all possible clefts that may exist.

Embryologically Based Classification Specifies Gender Differences in the Prevalence of Orofacial Cleft Subphenotypes

“…In general, these classifications and the International Classification of Diseases-10 (World Health Organization) are extremely useful for epidemiological analysis of OFC but are not sufficiently accurate in grouping OFC into subphenotypes for etiological and clinical studies (Luijsterburg et al, 2014;McBride et al, 2016;Vermeij-Keers et al, 2018). However, more detailed registry systems are known that distinguish the different anatomical structures (eg, Kernahan, 1971;Schwartz et al, 1993;Hammond & Stassen, 1999;Kubon et al, 2007) as well as the morphological features (eg, Kriens, 1989;Smith et al, 1998;Ortiz-Posadas et al, 2001;Koul, 2007;Liu et al, 2007;Allori et al, 2017). The LAHSHAL documentation system (representing Lip, Alveolus, Hard palate, and Soft palate) precisely registers the side, localization, and extent of a cleft or combination of clefts, with complete and incomplete clefts recorded in capital and small letters, respectively.…”

Eighteen-Year Follow-Up of 160 Consecutive Individuals Born With Unilateral Cleft Lip or Cleft Lip and Alveolus Treated by the Oslo Cleft Lip and Palate Team

“…Many classifications have been designed to include the clefts’ different characteristics (Kernahan and Stark, 1958; Kernahan, 1971; Elsahy, 1973; Friedman et al, 1991; Schwartz et al, 1993; Smith et al, 1998; Allori et al, 2017; Naran et al, 2017). One can argue these classifications still do not adequately characterize many features of the clefts, such as magnitude of segment separation (Ortiz-Posadas et al, 2001). However, it is undeniably difficult to precisely place the diverse spectrum of clefts into well-defined classifications, particularly in retrospective studies.…”

A revised classification of the cleft lip and palate

“…C left lip and palate represent the most common oromaxillofacial congenital anomalies and affect one in 500 to one in 1000 newborns worldwide (1). The surgeon must account for the diverse characteristics associated with the severity of cleft lip and palate deformities (2). To precisely describe the types, exact location and extent of the deformities, surgeons and nonmedical clerks need a classification system that is easy to understand and document, and that transcends language barriers and is applicable to computer data analysis (1).…”