Simonart's Band: Its Effect on Cleft Classification and Recommendations for Standardized Nomenclature

Abstract

Responses revealed wide discrepancy in the classification of cleft phenotypes and in the interpretation of the significance of anatomical components in the classification of a cleft lip. We discuss the difficulty in aligning classification based on unclear definition of terms and variable anatomic parameters. We highlight this issue in the face of a need for comparability in clinical evidence-based practices. To ensure precision and uniformity in cleft classification, we recommend that use of the term "Simonart's band" be abandoned while incorporating a notation of the integrity of the nasal sill into the LAHSHAL system. We propose a uniform definition of incomplete versus complete cleft lip, wherein a cleft lip will be classified as complete in the presence or absence of narrow bands of tissue present at the base of the nasal sill or more internally.

Prevalence of Simonart’s band in cleft children at a cleft center in Indonesia: A nine-year retrospective study

“…Naran et al conducted a survey on 373 respondents who were members of the American Cleft Palate-Craniofacial Association (ACPA). 12 As many as 87.1% of them agreed that the presence of Simonart's band was a condition that existed in cases of complete cleft lip. The authors suggested that if the soft-tissue band is at or above the line from the alar-facial groove to the columellar-philtral junction, the condition is classified as complete cleft lip, whereas if the soft-tissue band is below the abovementioned line, the condition is classified as incomplete cleft lip.…”

“…The word "Simonart" itself probably comes from "Simonarzt", a combination of Simon and "Arzt" -a German word for doctor. [11][12][13][14] Meanwhile, a Belgian obstetrician Dr. Pierre-Joseph Cécilien Simonart (1816-1846) described congenital bands in children, although he did not specifically describe the congenital band in the lip. [11][12][13] Yet, Simonart's band is more commonly known worldwide to indicate a soft tissue band in cleft lip and palate.…”

“…[11][12][13][14] Meanwhile, a Belgian obstetrician Dr. Pierre-Joseph Cécilien Simonart (1816-1846) described congenital bands in children, although he did not specifically describe the congenital band in the lip. [11][12][13] Yet, Simonart's band is more commonly known worldwide to indicate a soft tissue band in cleft lip and palate. 11,15 Kitamura postulates that soft tissue bands are formed by the portion of the lip or the alveolar region which escaped the post-fusion rupture.…”

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

“…In spite of their common embryonic origin, CL and CL+A are significantly different from one another from a clinical point of view, and the clefts may present diverse characteristics associated with their severity. 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).…”

A Beumer Classification of Labial-alveolar-palatal Clefts: Suggestion for Complement

“…The nomenclature committee of the American Cleft Palate Rehabilitation Association has published criteria for an ideal classification and mainly concern certain parameters: Definitions should be concise and clear, a logical distribution with the economy of expression and promotion of academic and clinical research by standardized procedures [3]. Indeed, a simple and comprehensive classification is better accepted scientifically [4]; it must be clearly defined and based on embryological criteria [5] and must allow the establishment of communication, the development of a treatment plan and the comparison of results between the different centers [6]. Since 1922, several classifications of orofacial clefts have been proposed with the aim of generalizing rational criteria allowing communication and exchange between the various practitioners.…”