Classification of cleft

Classification of cleft

Cleft lip and/or palate presents in a heterogeneous manner. In simple terms these conditions can be divided into two clinical types (phenotypes): - 1 isolated cleft palate; 2 cleft lip with or without involvement of the alveolus (tooth-bearing portion of the jaw) or palate. Within these broad classifications a variety of combinations of cleft type can exist. These all aim to define the extent and laterality of the cleft (left/right/bilateral) ( Figure 50.2 ). This - information is both diagnostic and, increasingly , of prognostic value. Many have argued for a single classification system to be Victor Veau , 1871–1949, French surgeon and author of several books on cleft lip and cleft palate surgery . Gunnar B Stickler , 1925–2010, born in Germany , Chair of Section of Paediatrics and later Paediatric Cardiology , The Mayo Clinic, Rochester, MN, USA. Angelo Mario DiGeorge , 1921–2009, Italian American physician and pediatric endocrinologist. John Langdon Haydon Down (sometimes given as Haydon-Down), 1828–1896, physician, The London Hospital, London, and Superintendent, Earlswood Asylum for Idiots, Surrey , UK, described this syndrome in 1866. adopted: even when the same system is being used, clinicians may interpret the findings inconsistently . In the UK, national audit data are collected for outcomes in unilateral cleft lip and palate (UCLP), thus allowing intercentre comparison. Cleft lip and/or palate is more common in males, whereas isolated cleft palate is more common in females. In UCLP the condition a ff ects the left side in 60% of cases. Summary box 50.1 Overview of cleft lip and palate /uni25CF /uni25CF /uni25CF /uni25CF

(a) Figure 50.1 (a) Unilateral cleft lip. (b) Bilateral cleft lip. (c) Isolated cleft palate. (a) L L Lip Lip A A Alveolus Alveolus Left Right H Hard palate S Soft palate (b) Class Description I Soft palate only II Hard and soft palate to the incisive foramen III Complete unilateral of soft, hard, lip and alveolar ridge IV Complete bilateral of soft, hard and/or lip and alveolar ridge Figure 50.2 (a) The LAHSHAL code. (b) The Veau classi /f_i cation system. (b) Cleft lip and/or palate has two main phenotypes Cleft palate is more common in females and cleft lip and/or palate is more common in males The incidence/prevalence demonstrates geographical variation There are simple classi /f_i cation systems that describe phenotype