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Classification of clefting deformity
Early Human Development, Elsevier
81
12 (1985) 81-85
EHD 00670
Classification of clefting deformity Andrew Sandham Dental School, University of Edinburgh, Edinburgh, Scotland, U.K. Accepted
for publication
26 April 1985
Summary
The classification of clefting deformity should be descriptively clear and have an embryological basis. Clinicians who use Veau classification make comparisons difficult and confusions can arise. Many proposals for grouping the various categories of the deformity have been put forward, the one suggested by Kernahan and Stark (Pla;stic Reconstruct. Surg.. 22 (1958) 435-441) being the most comprehensive. The classification described here is modified from Kernahan and Stark and is becoming more widely used as it is both simple and embryologically sound. clefting deformity; classification; embryological
Introduction
An investigation by Dahl [l] of the crania-facial morphology of children with congenital clefts of the lip and palate has revealed that various categories exist that have different morphological effects. The categories of clefting used in the Veau classification [5] have no sound developmental basis, and the proposals of Kernahan and Stark overcome this, but are rather complex. Fogh-Andersen [2] described the main types of facial cleft, and Harkins et al. [3] published classification proposals based on this earlier work. Dahl [l] divided clefts into three main groups consisting of cleft lip (CL), cleft palate (CP), and clefts of the lip and palate (CLP) which he further subdivided into unilateral clefts of the lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). A fifth group is added here which includes the rarer types of facial clefts. 0378-3782/85/$03.30
0 1985 Elsevier Science Publishers
B.V. (Biomedical
Division)
82
Fig. 1. (a) Cleft lip (CL), involves alveolar
process.
Fig. 1. (b) Cleft palate (CP), involves soft and hard palate.
83
Fig. 1 (c) Cleft lip and palate
Fig. 1. (d) Cleft lip and palate
(UCLP),
(BCLP),
unilateral
bilateral
cleft lip and palate (left).
cleft lip and palate.
84
Classification of clefting deformity
Cleft lip (CL). This involves the lip and alveolar process, the posterior limit being the incisive foramen. These structures are derived from the primary palate, and although a soft tissue defect only may be observed, radiographic examination reveals alveolar defects (Fig. la.)
Cleft palate (CP). This is a midline defect of hard and soft palate with the anterior limit at the incisive foramen. Like the soft tissue deformity in cleft lip has an associated bony defect, so the cleft of soft palate may have a submucous extension that involves the hard palate’(Fig. lb). Tw
3 Unilateral cleft lip and palate (UCLP).
the embryological (Fig. lc).
This defect represents a combination of defects that are responsible for the clefts of the lip and palate
Twe 4 Bilateral cleft lip and palate (BCLP).
A similar but more extensive defect of the primary and secondary palate than type 3 defects (Fig. Id).
Type5
Other types of cleft. This group includes the more rare types of facial clefting and includes median clefts of the lip and oblique facial clefts.
Conclusion
The lack of conformity in classification of cleft lip and palate deformity can cause confusion. This paper is written to describe the modified Kemahan and Stark classification, and to illustrate the various categories of cleft lip and palate deformity. The more widespread use of this classification can overcome the difficulties that arise when classifications are used that are not descriptively clear. The embryological basis of this classification assists management, and enables more meaningful grouping of the deformity to take place. This assists scientific study and comparison of data.
References 1 Dahl, E. (1970): Cranio-facial morphology in congenital clefts of the lip and palate. Acta Odontol. Stand., 28, suppl. 57, 13-15.
85 2 Fogh-Andersen, P. (1942): Inheritance of harelip and cleft palate. In: Nyt Nordisk Forlag, Copenhagen. pp. 12-17. 3 Harkins. C.S.A., Berlin, R.L., Harding. J.J.. Longacre, R. and Snodgrass. R.M. (1962): A classification of cleft lip and palate. Plastic Reconstruct. Surg., 29, 31-39. 4 Kernahan, D.A. and Stark, R.B. (1958): A new classification for cleft lip and palate. Plastic Reconstruct. Surg.. 22, 435-441. 5 Veau. V. (1938): Classification of clefting. In: Bet-de-Lievre. pp. l-5. Masson, Paris.
81
12 (1985) 81-85
EHD 00670
Classification of clefting deformity Andrew Sandham Dental School, University of Edinburgh, Edinburgh, Scotland, U.K. Accepted
for publication
26 April 1985
Summary
The classification of clefting deformity should be descriptively clear and have an embryological basis. Clinicians who use Veau classification make comparisons difficult and confusions can arise. Many proposals for grouping the various categories of the deformity have been put forward, the one suggested by Kernahan and Stark (Pla;stic Reconstruct. Surg.. 22 (1958) 435-441) being the most comprehensive. The classification described here is modified from Kernahan and Stark and is becoming more widely used as it is both simple and embryologically sound. clefting deformity; classification; embryological
Introduction
An investigation by Dahl [l] of the crania-facial morphology of children with congenital clefts of the lip and palate has revealed that various categories exist that have different morphological effects. The categories of clefting used in the Veau classification [5] have no sound developmental basis, and the proposals of Kernahan and Stark overcome this, but are rather complex. Fogh-Andersen [2] described the main types of facial cleft, and Harkins et al. [3] published classification proposals based on this earlier work. Dahl [l] divided clefts into three main groups consisting of cleft lip (CL), cleft palate (CP), and clefts of the lip and palate (CLP) which he further subdivided into unilateral clefts of the lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). A fifth group is added here which includes the rarer types of facial clefts. 0378-3782/85/$03.30
0 1985 Elsevier Science Publishers
B.V. (Biomedical
Division)
82
Fig. 1. (a) Cleft lip (CL), involves alveolar
process.
Fig. 1. (b) Cleft palate (CP), involves soft and hard palate.
83
Fig. 1 (c) Cleft lip and palate
Fig. 1. (d) Cleft lip and palate
(UCLP),
(BCLP),
unilateral
bilateral
cleft lip and palate (left).
cleft lip and palate.
84
Classification of clefting deformity
Cleft lip (CL). This involves the lip and alveolar process, the posterior limit being the incisive foramen. These structures are derived from the primary palate, and although a soft tissue defect only may be observed, radiographic examination reveals alveolar defects (Fig. la.)
Cleft palate (CP). This is a midline defect of hard and soft palate with the anterior limit at the incisive foramen. Like the soft tissue deformity in cleft lip has an associated bony defect, so the cleft of soft palate may have a submucous extension that involves the hard palate’(Fig. lb). Tw
3 Unilateral cleft lip and palate (UCLP).
the embryological (Fig. lc).
This defect represents a combination of defects that are responsible for the clefts of the lip and palate
Twe 4 Bilateral cleft lip and palate (BCLP).
A similar but more extensive defect of the primary and secondary palate than type 3 defects (Fig. Id).
Type5
Other types of cleft. This group includes the more rare types of facial clefting and includes median clefts of the lip and oblique facial clefts.
Conclusion
The lack of conformity in classification of cleft lip and palate deformity can cause confusion. This paper is written to describe the modified Kemahan and Stark classification, and to illustrate the various categories of cleft lip and palate deformity. The more widespread use of this classification can overcome the difficulties that arise when classifications are used that are not descriptively clear. The embryological basis of this classification assists management, and enables more meaningful grouping of the deformity to take place. This assists scientific study and comparison of data.
References 1 Dahl, E. (1970): Cranio-facial morphology in congenital clefts of the lip and palate. Acta Odontol. Stand., 28, suppl. 57, 13-15.
85 2 Fogh-Andersen, P. (1942): Inheritance of harelip and cleft palate. In: Nyt Nordisk Forlag, Copenhagen. pp. 12-17. 3 Harkins. C.S.A., Berlin, R.L., Harding. J.J.. Longacre, R. and Snodgrass. R.M. (1962): A classification of cleft lip and palate. Plastic Reconstruct. Surg., 29, 31-39. 4 Kernahan, D.A. and Stark, R.B. (1958): A new classification for cleft lip and palate. Plastic Reconstruct. Surg.. 22, 435-441. 5 Veau. V. (1938): Classification of clefting. In: Bet-de-Lievre. pp. l-5. Masson, Paris.