Cleft lip classification systems

Classification

1. Veau classification

Classification system proposed in 1938.

Group I (A)

Defects of the soft palate alone

Group II (B)

Defects involving the hard and soft palates (not extending anterior to the incisive foramen)

Group III (C)

Defects involving the palate through to the alveolus

Group IV (D)

Complete bilateral clefts.

2,Kernahan and Stark classification [2]

Embryology-based classification system proposed in 1958 that designates the incisive foramen as the dividing line between the primary and secondary palates.

The incisive foramen is a funnel-shaped opening through which neurovascular bundles pass. It is located in the hard palate behind the middle upper teeth (incisors). This structure is an important embryological landmark, which is used to define the boundary between the primary and secondary palate.

Primary palate includes those structures anterior to the incisive foramen (lip, pre-maxilla, anterior septum).
Secondary palate includes those structures posterior to the incisive foramen (lateral palatine shelves, soft palate, and uvula).

3.Kernahan classification [3]

Classification system based on the resemblance of an intra-oral view of a cleft lip and palate to the letter 'Y', proposed in 1971.

The area affected by the cleft is marked on the 'Y' and labelled from 1 to 9, each of which represents a different anatomical structure. Combinations of the numeric values represent the appearance of the cleft lip, alveolus, or palate. View image

Areas 1 and 4 represent the right and left side of the nasal floor, respectively.
Areas 2 and 5 represent the right and left side of the lip, respectively.
Areas 3 and 6 represent the right and left side of the paired alveolar segment, respectively.
Area 7 represents the primary palate.
Areas 8 and 9 represent the secondary palate.

4.Harkins' classification [4]

Classification system proposed in 1962.

Cleft of primary palate

Cleft lip
Alveolar cleft

Cleft of secondary palate

Soft palate
Hard palate

Mandibular process clefts
Naso-ocular clefts: involving the nose towards the medial canthal region
Oro-ocular clefts: extending from the oral commissure towards the palpebral fissure
Oro-aural clefts: extending from the oral commissure towards the auricle.

5.Spina classification [5]

Classification system proposed in 1974.

Pre-incisive foramen clefts (lip ± alveolus)

Unilateral
Bilateral
Median

Trans-incisive foramen cleft (lip, alveolus, palate)

Unilateral
Bilateral

Post-incisive foramen clefts (secondary cleft palate)
Atypical (rare) facial clefts.

6.Tessier's classification [6]

Tessier described a classification scheme that is universally utilised, in a landmark article of 1976. View image View image

Oro-facial clefts can manifest as:

Unilateral or bilateral
Complete, incomplete, or microform (e.g., sub-mucous cleft palate)
Clefting of the lip with or without the palate, or of the palate in isolation
Atypical cranio-facial clefts.

7.DAVIS AND RITCHIE CLASSIFICATION:

The following classification was proposed by
Davis and Ritchie in 1922.
This system broadly categorized the clefts into three groups according to position of cleft in relation to alveolar process.
Group I – Pre alveolar clefts:
• Unilateral cleft lip
• Bilateral cleft lip
• Median cleft lip
Group II - Post alveolar clefts:
• Cleft hard palate alone
• Cleft soft palate alone
• Cleft soft palate and hard palate
• Sub mucous cleft
Group III-Alveolar clefts:
• Unilateral alveolar cleft
• Bilateral alveolar cleft
• Median alveolar cleft

8.ARTURO SANTIAGO CLASSIFICATION:

Santiago A8 proposed a classification in 1969 in which he used four digits to indicate presence of cleft and its location. Each digit is followed by letter to indicate condition of cleft (complete, incomplete or

sub mucous). Four digits represent the following four structures

affected by cleft.

• The first digit refers to the lip.

• The second digit refers to the alveolus.

• The third digit refers to the hard palate.

• The fourth digit refers to the soft palate.

The numbers used as digits represents the condition of cleft.

• 0= No cleft

• 1= Midline cleft

• 2= Cleft on right side

• 3= Cleft on left side

• 4= Bilateral cleft

The letters indicate more specifically the type of cleft.

• A = An incomplete midline cleft

• B = An incomplete cleft of right side

• C = An incomplete cleft of left side

• D = Bilateral incomplete cleft

• E = Sub mucous cleft

LAHSAL CLASSIFICATION OF CLEFT LIP AND PALATE:

Kreins O (cited by Hodgkinson et al)9 proposed

LAHSHAL system for classification of cleft lip and

palate patients which was modified on the recommendation

of Royal College of Surgeons Britain in 2005

by omitting one “H” from the acronym “LAHSHAL”. LAHSAL system is a diagrammatic classification

of cleft lip and palate. According to this classification,

mouth is divided into six parts.

• Right lip

• Right alveolus

• Hard palate

• Soft palate (LAHSAL)

• Left alveolus

• Left lip

• The first character is for patient’s right lip and

last character for patient’s left lip.

• LAHSAL code indicates complete cleft with

capital letter and an incomplete cleft with small

letter.

No cleft is represented with a dot.

10. ELNASSRY CLASSIFICATION:

Elnassry10 proposed following classification in

2007. He divided cleft lip and palate patients in to

seven classes.

Class I: Unilateral cleft lip

Class II: Unilateral cleft lip and alveolus

Class III: Bilateral cleft lip and alveolus

Class IV: Unilateral complete cleft lip and palate

Class V: Bilateral complete cleft lip and palate

Class VI: Cleft hard palate

Class VII: Bifid uvula