Classification of Cleft Lip/Palate: Then and Now

Abstract

Cleft lip and/or palate (CL/P) is phenotypically diverse, making classification difficult. This article explores the evolution of ideas regarding CL/P classification and includes the schemes described by Davis and Ritchie (1922) , Brophy (1923) , Veau (1931) , Fogh-Andersen (1943), Kernahan and Stark (1958) , Harkins et al. (1962) , Broadbent et al. (1968), Spina (1973) , and others. Based on these systems, a longhand structured form is proposed for describing CL/P in a way that is clear, comprehensive, and consistent. A complementary shorthand notation is also described to improve the utility and convenience of this structured form.

An algorithm for predicting Robin sequence from fetal MRI

“…Potential predictive variables were chosen on the basis of observations and measurements from the fetal MRI including amount of amniotic fluid (normal, polyhydramnios, oligohydramnios); presence and Veau type of cleft palate (Figure ); tongue characteristics (tongue height, length, and width; “tongue shape index” (TSI), defined as the ratio of tongue height to tongue length (Figure ); “tongue touches posterior pharyngeal wall,” defined as a binary variable determined by observation of the tongue completely occluding the oropharynx and contacting the posterior pharyngeal wall on any MRI slice, mandibular size, and position (inferior facial angle [IFA], jaw index); and oropharyngeal space (OPS) . For IFA, lines were drawn orthogonal to the forehead at the level of the nasofrontal suture and from the tip of the chin to the anterior border of the most protruding lip, and IFA was measured as the angle formed by the intersection of these lines (Figure ) .…”

A Population-Based Exploration of the Social Implications Associated with Cleft Lip and/or Palate

“…Orofacial clefts can be divided into 4 major classes: cleft lip only (CL), cleft lip with cleft alveolus (CL + A), cleft lip with cleft palate (CL + P), and cleft palate only (CP). 35,36 Considering that the North Carolina Birth-Defects Monitoring Program and medical records did not reliably describe the presence or absence of an alveolar cleft, for the purposes of this study, CL and CL + A were combined into a single category: cleft lip with/without cleft alveolus (CL ± A). In addition, severity of the cleft lip (complete, incomplete, or lesser form), laterality (unilateral or bilateral), and morphology of the cleft palate (e.g., Veau I–IV) were not consistently available from the birth defect registry or medical records and was therefore not considered in this exploratory analysis.…”

Striped-Y redux: Redesigning pictographic notational systems for the digital age

“…Critical appraisal of cleft classification systems was previously performed [4]. Additionally, administrative coding schema such as the International Classification of Diseases represented included plastic surgery, oral/maxillofacial surgery, otorhinolaryngology, dentistry, speech/language pathology, audiology, nursing, prenatal ultrasonography, and team coordination/ administration.…”

“…In the above example (keeping the labial and palatal settings the same), the alveolar slider could be adjusted to "normal" (intact alveolus), resulting in "unilateral complete cleft lip and Veau-II cleft palate" ([ucCLPv2] or [L•HS•••]). Furthermore, the application would automatically generate the correct phenotypic description, notation (e.g., LAHSHAL and/or CLAP notation [4]), and codes from various codesets (e.g., Figure 5. Conceptual design of a touch-based user interface designed for the Apple iPad and intended to streamline digital data entry.…”