Skip to main content

Classifying the Wide Clinical Spectrum of Cleft Lip and Palate

  • Chapter
  • First Online:
Current Concept in Cleft Surgery

Abstract

Orofacial clefts present a broad phenotypic expression, with several possible clinical combinations of unilateral or bilateral cleft lip with or without cleft palate. Multiple cleft classification systems have been proposed to assist diagnosis, clinical and surgical management, and research, but none sufficiently encompass all the cleft phenotypes. This chapter provides a broad description of cleft classification systems. It also highlights the wide clinical spectrum of cleft lip and palate, encompassing the well-recognized overt cleft forms and the new-described subclinical cleft forms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abbas HH, Hicks Y, Zhurov A, et al. An automatic approach for classification and categorisation of lip morphological traits. PLoS One. 2019;14(10):e0221197.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Agrawal K. Classification of cleft lip and palate: an Indian perspective. J Cleft Lip Palate Craniofac Anomal. 2014;1:78–84.

    Article  Google Scholar 

  • Allori AC, Cragan JD, Cassell CH, Marcus JR. ICD-10-based expanded code set for use in cleft lip/palate research and surveillance. Birth Defects Res A Clin Mol Teratol. 2016;106(11):905–14.

    Article  CAS  PubMed  Google Scholar 

  • Allori AC, Cragan JD, Della Porta GC, et al. Clinician’s primer to ICD-10-CM coding for cleft lip/palate care. Cleft Palate Craniofac J. 2017a;54(1):e7–e13.

    Article  PubMed  Google Scholar 

  • Allori AC, Mulliken JB, Meara JG, Shusterman S, Marcus JR. Classification of cleft lip/palate: then and now. Cleft Palate Craniofac J. 2017b;54(2):175–88.

    Article  PubMed  Google Scholar 

  • Balakrishnan C. Indian classification of cleft lip and palate. Indian J Plast Surg. 1975;8:23–4.

    Google Scholar 

  • Boyce JO, Raj S, Sanchez K, Marazita ML, Morgan AT, Kilpatrick N. Speech phenotyping in unaffected family members of individuals with nonsyndromic cleft lip with or without palate. Cleft Palate Craniofac J. 2019;56(7):867–76.

    Article  PubMed  Google Scholar 

  • Broadbent TR, Fogh-Andersen P, Berlin AJ, Karfik V, Matthews DN, Pfeifer G. Report of the Subcommittee on Nomenclature and Classification of Clefts of Lip, Alveolus and Palate and Proposals for Further Activities. In: Newsletter of the International Confederation for Plastic and Reconstructive Surgery. Amsterdam: Elsevier; 1969.

    Google Scholar 

  • Brophy TW. Cleft lip and palate. Ann Surg. 1924;79:154–7.

    Article  Google Scholar 

  • Campbell A, Restrepo C, Deshpande G, et al. Validation of the unilateral cleft lip severity index for surgeons and laypersons. Plast Reconstr Surg Glob Open. 2017;5(9):e1479. https://doi.org/10.1097/GOX.0000000000001479.

    Article  PubMed  PubMed Central  Google Scholar 

  • Castilla EE, Orioli IM. ECLAMC: the Latin-American collaborative study of congenital malformations. Commun Genet. 2004;7(2–3):76–94.

    Google Scholar 

  • Chernus J, Roosenboom J, Ford M, Lee MK, Emanuele B, Anderton J, Hecht JT, Padilla C, Deleyiannis FWB, Buxo CJ, et al. GWAS reveals loci associated with velopharyngeal dysfunction. Sci Rep. 2018;8(1):8470.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg. 1991;87:1041–7.

    Article  CAS  PubMed  Google Scholar 

  • Dahl E. Cranio-facial morphology in congenital clefts of the lip and palate. Acta Odontol Stand. 1970;28(Suppl 57):13–5.

    Google Scholar 

  • Daigavane PS, Hazarey PV, Niranjane P, Vasudevan SD, Thombare BR, Daigavane S. A new classification system for unilateral cleft lip and palate infants to assist presurgical infant orthopedics. J Clin Pediatr Dent. 2015;39(3):231–4. https://doi.org/10.17796/1053-4628-39.3.231.

    Article  CAS  PubMed  Google Scholar 

  • Davis JS, Ritchie HP. Classification of congenital clefts of the lip and palate. JAMA. 1922;79:1323–7.

    Article  Google Scholar 

  • Davison JA, Mirlohi H, Rowsell AR. Modified diagram of Friedman’s symbolic representation of cleft lip and palate anomalies. Br J Plast Surg. 1998;51(4):281–4. https://doi.org/10.1054/bjps.1997.0265.

    Article  CAS  PubMed  Google Scholar 

  • Delestan C, Montoya P, Doucet JC, et al. New neonatal classification of unilateral cleft lip and palate-part 1: to predict primary lateral incisor agenesis and inherent tissue hypoplasia. Cleft Palate Craniofac J. 2014;51(4):392–9. https://doi.org/10.1597/12-113.

    Article  PubMed  Google Scholar 

  • Denadai R, Seo HJ, Lo LJ. Persistent symptomatic anterior oronasal fistulae in patients with Veau type III and IV clefts: a therapeutic protocol and outcomes. J Plast Reconstr Aesthet Surg. 2020a;73(1):126–33. https://doi.org/10.1016/j.bjps.2019.05.033.

    Article  PubMed  Google Scholar 

  • Denadai R, Zanco GL, Raposo-Amaral CA, Buzzo CL, Raposo-Amaral CE. Outcomes of surgical management of palatal fistulae in patients with repaired cleft palate. J Craniofac Surg. 2020b;31(1):e45–50. https://doi.org/10.1097/SCS.0000000000005852.

    Article  PubMed  Google Scholar 

  • Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011;12(3):167–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Doucet JC, Delestan C, Montoya P, et al. New neonatal classification of unilateral cleft lip and palate part 2: to predict permanent lateral incisor agenesis and maxillary growth. Cleft Palate Craniofac J. 2014;51(5):533–9. https://doi.org/10.1597/12-114.

    Article  PubMed  Google Scholar 

  • El Sergani AM, Brandebura S, Padilla C, Butali A, Adeyemo WL, Valencia-Ramírez C, Muñeton CPR, Moreno LM, Buxó CJ, Long RE Jr, Neiswanger K, Shaffer JR, Marazita ML, Weinberg SM. Parents of children with nonsyndromic orofacial clefting show altered palate shape. Cleft Palate Craniofac J. 2020:1055665620967235. https://doi.org/10.1177/1055665620967235.

  • Elsahy NI. The modified striped Y—a systematic classification for cleft lip and palate. Cleft Palate J. 1973;10:247–50.

    CAS  PubMed  Google Scholar 

  • Elsherbiny A, Mazeed AS. Comprehensive and reliable classification system for primary diagnosis of cleft lip and palate. J Craniomaxillofac Surg. 2017;45:1010–7.

    Article  PubMed  Google Scholar 

  • Farina A, Wyszynski DF, Pezzetti F, et al. Classification of oral clefts by affection site and laterality: a genotype-phenotype correlation study. Orthod Craniofacial Res. 2002;5:185.

    Article  CAS  Google Scholar 

  • Fayyaz GQ, Gill NA, Ishaq I, et al. Pakistan comprehensive fistula classification: a novel scheme and algorithm for management of palatal fistula/dehiscence. Plast Reconstr Surg. 2019;143(1):140e–51e.

    Article  CAS  PubMed  Google Scholar 

  • Felemovicius J, Taylor JA. Apples and oranges-midface hypoplasia and the Le Fort I osteotomy in cleft lip and palate patients: a classification scheme and treatment protocol. Cleft Palate Craniofac J. 2009;46(6):613–20. https://doi.org/10.1597/08-161.1.

    Article  PubMed  Google Scholar 

  • Fogh-Andersen P. Inheritance of harelip and cleft palate. Copenhagen: Nyt Nordisk Forlag, Arnold Busck; 1942.

    Google Scholar 

  • Fogh-Andersen P. Epidemiology and etiology of clefts. Birth Defects Orig Artic Ser. 1971a;7(7):50–3.

    CAS  PubMed  Google Scholar 

  • Fogh-Andersen P. Epidemiology and etiology of clefts. In: Bergsma D, editor. Third Conference on the Clinical Delineation of Birth Defects. Baltimore, MD: Williams and Wilkins; 1971b.

    Google Scholar 

  • Friedman HI, Sayetta RB, Coston GN, Hussey JR. Symbolic representation of cleft lip and palate. Cleft Palate Craniofac J. 1991;28(3):252–9; discussion 259–60.

    Article  CAS  PubMed  Google Scholar 

  • Gosla Reddy S, Shah R, Ansari S, Reddy RR, Fanan A. Efficacy of morpho-functional repair in management of different morphological variants of unilateral complete cleft lip. J Craniomaxillofac Surg. 2019;47(10):1569–76.

    Article  PubMed  Google Scholar 

  • Hanson JW, Murray JC. Genetic aspects of cleft lip and palate. In: Morris HL, Bardach J, editors. The multi-disciplinary management of cleft lip and palate. Philadelphia, PA: WB Saunders; 1990.

    Google Scholar 

  • Harkins CS, Berlin A, Harding RL, Longacre JJ, Snodgrasse RM. A classification of cleft lip and cleft palate. Plast Reconstr Surg Transpl Bull. 1962;29:31–9.

    Article  CAS  Google Scholar 

  • Houkes R, Smit J, Mossey P, Don Griot P, Persson M, Neville A, Ongkosuwito E, Sitzman T, Breugem C. Classification systems of cleft lip, alveolus and palate: results of an international survey. Cleft Palate Craniofac J. 2021:10556656211057368. https://doi.org/10.1177/10556656211057368.

  • Jensen BL, Kreiborg S, Dahl E, Fogh-Andersen P. Cleft lip and palate in Denmark, 1976-1981: epidemiology, variability, and early somatic development. Cleft Palate J. 1988;25:258–69.

    CAS  PubMed  Google Scholar 

  • Johnston MC, Bronsky PT. Craniofacial embryogenesis: abnormal developmental mechanisms. In: Mooney MP, Siegel MI, editors. Understanding craniofacial anomalies: the etiopathogenesis of craniosynostosis and facial clefting. New York, NY: John W Wiley & Sons; 2002.

    Google Scholar 

  • Jones JL, Canady JW, Brookes JT, et al. Wound complications after cleft repair in children with Van der Woude syndrome. J Craniofac Surg. 2010;21:1350.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jugessur A, Farlie PG, Kilpatrick N. The genetics of isolated orofacial clefts: from genotypes to subphenotypes. Oral Dis. 2009;15:437.

    Article  CAS  PubMed  Google Scholar 

  • Kernahan DA. The striped Y — a symbolic classification for cleft lip and palate. Plast Reconstr Surg. 1971;47:469–70.

    Article  CAS  PubMed  Google Scholar 

  • Kernahan DA, Stark RB. A new classification for cleft lip and cleft palate. Plast Reconstr Surg Transpl Bull. 1958;22(5):435–41.

    Article  CAS  Google Scholar 

  • Khan M, Ullah H, Naz S, Iqbal T, Ullah T, Tahir M, Ullah O. A revised classification of the cleft lip and palate. Can J Plast Surg. 2013;21(1):48–50.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klotz CM, Wang X, Desensi RS, et al. Revisiting the recurrence risk of nonsyndromic cleft lip with or without cleft palate. Am J Med Genet A. 2010;152A:2697.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koch H, Grzonka M, Koch J. Cleft malformation of lip, alveolus, hard and soft palate, and nose (LAHSN)--a critical view of the terminology, the diagnosis and gradation as a basis for documentation and therapy. Br J Oral Maxillofac Surg. 1995;33(1):51–8.

    Article  CAS  PubMed  Google Scholar 

  • Koul R. Describing cleft lip and palate using a new expression system. Cleft Palate Craniofac J. 2007;44(6):585–9.

    Article  PubMed  Google Scholar 

  • Kriens O. LAHSHAL. A concise documentation system for cleft lip, alvolus and palate diagnoses. In: Kriens O, editor. What is cleft lip and palate? a multidisciplinary update workshop, Bremen 1987. Stuttgart: Thieme; 1989.

    Google Scholar 

  • Leslie EJ, Marazita ML. Genetics of cleft lip and cleft palate. Am J Med Genet C: Semin Med Genet. 2013;163C(4):246–58.

    Article  Google Scholar 

  • Letra A, Menezes R, Granjeiro JM, et al. Defining subphenotypes for oral clefts based on dental development. J Dent Res. 2007;86:986.

    Article  CAS  PubMed  Google Scholar 

  • Lin HH, Chiang WC, Yang CT, Cheng CT, Zhang T, Lo LJ. On construction of transfer learning for facial symmetry assessment before and after orthognathic surgery. Comput Methods Prog Biomed. 2021;200:105928. https://doi.org/10.1016/j.cmpb.2021.105928.

    Article  Google Scholar 

  • Liu Q, Yang ML, Li ZJ, Bai XF, Wang XK, Lu L, Wang YX. A simple and precise classification for cleft lip and palate: a five-digit numerical recording system. Cleft Palate Craniofac J. 2007;44(5):465–8.

    Article  PubMed  Google Scholar 

  • Lo LJ, Yang CT, Ho CT, Liao CH, Lin HH. Automatic assessment of 3-dimensional facial soft tissue symmetry before and after orthognathic surgery using a machine learning model: a preliminary experience. Ann Plast Surg. 2021;86:S224. https://doi.org/10.1097/SAP.0000000000002687.

    Article  CAS  PubMed  Google Scholar 

  • Luijsterburg AJ, Vermeij-Keers C. Ten years recording common oral clefts with a new descriptive system. Cleft Palate Craniofac J. 2011;48(2):173–82.

    Article  PubMed  Google Scholar 

  • Luijsterburg AJ, Rozendaal AM, Vermeij-Keers C. Classifying common oral clefts: a new approach after descriptive registration. Cleft Palate Craniofac J. 2014;51(4):381–91.

    Article  PubMed  Google Scholar 

  • Marazita ML, Mooney MP. Current concepts in the embryology and genetics of cleft lip and cleft palate. Clin Plast Surg. 2004;31:125.

    Article  PubMed  Google Scholar 

  • Marazita M, Cooper M, Ford M, et al. Velopharyngeal insufficiency (VPI) in families of individuals with cleft lip with or without cleft palate (CL/P). Presented at the Twelfth International Congress on Cleft Lip/Palate and Related Craniofacial Anomalies, Lake Buena Vista, FL; 2013.

    Google Scholar 

  • McBride WA, McIntyre GT, Carroll K, Mossey PA. Subphenotyping and classification of orofacial clefts: need for orofacial cleft sub- phenotyping calls for revised classification. Cleft Palate Craniofac J. 2016;53(5):539–49.

    Article  CAS  PubMed  Google Scholar 

  • Menezes R, Vieira AR. Dental anomalies as part of the cleft spectrum. Cleft Palate Craniofac J. 2008;45:414.

    Article  PubMed  Google Scholar 

  • Mittal M, Maheshwari N, Ahlawat K, et al. Detection of orbicularis oris muscle defects in first degree relatives of cleft lip children using ultrasound. J Indian Soc Pedod Prev Dent. 2012;30:237.

    Article  CAS  PubMed  Google Scholar 

  • Mooney MP, Heike CL, Naran S, Weinberg SM. Classification of orofacial clefts. In: Losee JE, Kirschner RE, editors. Comprehensive cleft care. 2nd ed. New York, NY: McGraw-Hill; 2015.

    Google Scholar 

  • Mulliken JB, Schmidt AG. Gustav Simon’s band and the evolution of labial adhesion. J Craniofac Surg. 2013;24(1):108–14.

    Article  PubMed  Google Scholar 

  • Naran S, Kirschner RE, Schuster L, et al. Simonart’s band: its effect on cleft classification and recommendations for standardized nomenclature. Cleft Palate Craniofac J. 2017;54(6):726–33. https://doi.org/10.1597/15-319.

    Article  PubMed  Google Scholar 

  • Natsume N, Suzuki T, Kawai T. Clinical analysis of the cleft patterns of lip and palate. Cong Anom. 1984;24:75–82.

    Article  Google Scholar 

  • Neiswanger K, Cooper ME, Weinberg SM, et al. Cleft lip with or without cleft palate and dermatoglyphic asymmetry: evaluation of a Chinese population. Orthod Craniofacial Res. 2002;5:140.

    Article  CAS  Google Scholar 

  • Neiswanger K, Weinberg SM, Rogers CR, Brandon CA, Cooper ME, Bardi KM, Deleyiannis FWB, Resick JR, Bowen A, Mooney MP, de Salamanca JE, Gonzalez B, Maher BS, Martin RA, Marazita ML. Orbicularis oris muscle defects as an expanded phenotypic feature in nonsyndromic cleft lip with or without cleft palate. Am J Med Genet. 2007;143A(11):1143–9.

    Article  PubMed  Google Scholar 

  • Neiswanger K, Chirigos KW, Klotz CM, Cooper ME, Bardi KM, Brandon CA, Weinberg SM, Vieira AR, Martin RA, Czeizel AE, Castilla EE, Poletta FA, Marazita ML. Whorl patterns on the lower lip are associated with nonsyndromic cleft lip with or without cleft palate. Am J Med Genet A. 2009;149A(12):2673–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Noordhoff MS. Multidisciplinary management of cleft lip and palate in Taiwan. In: Bardach J, Morris HL, editors. Multidisciplinary management of cleft lip and palate. Philadelphia, PA: Saunders; 1990.

    Google Scholar 

  • Nopoulos P, Richman L, Murray J, Canady J. Cleft palate and craniofacial conditions. Cleft Palate Craniofac J. 2002;39(1):123–4.

    PubMed  Google Scholar 

  • Onizuka T, Hosaka Y, Aoyama R, Takahama H, Jinnai T, Usui Y. Operations for microforms of cleft lip. Cleft Palate Craniofac J. 1991;28(3):293–300.

    Article  CAS  PubMed  Google Scholar 

  • Ortiz-Posadas MR, Vega-Alvarado L, Maya-Behar J. A new approach to classify cleft lip and palate. Cleft Palate Craniofac J. 2001;38:545–50.

    Article  CAS  PubMed  Google Scholar 

  • Pool SMW, der Lek LMV, de Jong K, Vermeij-Keers C, Mouës-Vink CM. Embryologically based classification specifies gender differences in the prevalence of orofacial cleft subphenotypes. Cleft Palate Craniofac J. 2021;58(1):54–60. https://doi.org/10.1177/1055665620935363.

    Article  PubMed  Google Scholar 

  • Pruzansky S. Description, classification, and analysis of unoperated clefts of lip and palate. Am J Orthod. 1953;39:590–611. https://doi.org/10.1016/0002-9416(53)90075-X.

    Article  Google Scholar 

  • Randall P, LaRossa D, McWilliams BJ, Cohen M, Solot C, Jawad AF. Palatal length in cleft palate as a predictor of speech outcome. Plast Reconstr Surg. 2000;106(6):1254–61.

    Article  CAS  PubMed  Google Scholar 

  • Richardson S, Agni NA. Palatal fistulae: a comprehensive classification and difficulty index. J Maxillofac Oral Surg. 2014;13:305–9.

    Article  PubMed  Google Scholar 

  • Richardson S, Krishna S, Khandeparker RV. A comprehensive management protocol to treat cleft maxillary hypoplasia. J Craniomaxillofac Surg. 2018;46(2):356–61. https://doi.org/10.1016/j.jcms.2017.12.005.

    Article  PubMed  Google Scholar 

  • Rodrigues R, Fernandes MH, Monteiro AB, et al. SPINA classification of cleft lip and palate: a suggestion for a complement. Arch Pediatr. 2018;25(7):439–41.

    Article  CAS  PubMed  Google Scholar 

  • Ross RB, Johnston MC. Cleft lip and palate. New York, NY: R Krieger; 1979.

    Google Scholar 

  • Rossell-Perry P. New classification of cleft lip and palate’s severity. Acta Med Peruana. 2006;23:59–66.

    Google Scholar 

  • Rossell-Perry P. New diagram for cleft lip and palate description: the clock diagram. Cleft Palate Craniofac J. 2009;46:305–13.

    Article  PubMed  Google Scholar 

  • Rossell-Perry P, Gavino-Gutierrez AM. Asymmetric bilateral cleft lip: classification and a surgical technique. J Craniofac Surg. 2012;23(5):1367–72. https://doi.org/10.1097/SCS.0b013e31824f6480.

    Article  PubMed  Google Scholar 

  • Rossell-Perry P, Caceres Nano E, Gavino-Gutierrez AM. Association between palatal index and cleft palate repair outcomes in patients with complete unilateral cleft lip and palate. JAMA Facial Plast Surg. 2014;16(3):206–10.

    Article  PubMed  Google Scholar 

  • Rossell-Perry P, Cotrina-Rabanal O, Barrenechea-Tarazona L, Vargas-Chanduvi R, Paredes-Aponte L, Romero-Narvaez C. Mucoperiosteal flap necrosis after primary palatoplasty in patients with cleft palate. Arch Plast Surg. 2017;44(3):217–22. https://doi.org/10.5999/aps.2017.44.3.217.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sandham A. Classification of clefting deformity. Early Hum Dev. 1985;12(1):81–5.

    Article  CAS  PubMed  Google Scholar 

  • Santiago A. Classification of cleft lip and palate for machine record coding. Cleft Palate J. 1969;6:434–9.

    CAS  PubMed  Google Scholar 

  • Saralaya S, Desai AK, Kumar N. Difficulty index-based management of palatal fistula after primary cleft palate repair: an institutional experience. J Oral Maxillofac Surg. 2019;77(4):851.e1–7.

    Article  Google Scholar 

  • Schwartz S, Kapala JT, Rajchgot H, Roberts GL. Accurate and systematic numerical recording system for the identification of various types of lip and maxillary clefts (RPL system). Cleft Palate Craniofac J. 1993;30:330–2.

    Article  CAS  PubMed  Google Scholar 

  • Scott NM, Weinberg SM, Neiswanger K, et al. Dermatoglyphic pattern types in subjects with nonsyndromic cleft lip with or without cleft palate (CL/P) and their unaffected relatives in the Philippines. Cleft Palate Craniofac J. 2005;42:362.

    Article  PubMed  Google Scholar 

  • Sittah GA, Ghanem OA, Hamdan U, Ramia P, Zgheib E. Secondary cleft nasolabial deformities: a new classification system for evaluation and surgical revision. Cleft Palate Craniofac J. 2018;55(6):837–43. https://doi.org/10.1597/16-064.

    Article  PubMed  Google Scholar 

  • Smith AW, Khoo AK, Jackson IT. A modification of the Kernahan “Y” classification in cleft lip and palate deformities. Plast Reconstr Surg. 1998;102:1842–7.

    Article  CAS  PubMed  Google Scholar 

  • Smith DM, Vecchione L, Jiang S, et al. The Pittsburgh Fistula Classification System: a standardized scheme for the description of palatal fistulas. Cleft Palate Craniofac J. 2007;44(6):590–4.

    Article  PubMed  Google Scholar 

  • Spina V. A proposed modification for the classification of cleft lip and cleft palate. Cleft Palate J. 1973;10:251–2.

    CAS  PubMed  Google Scholar 

  • Spina V, Psillakis JM, Lapa FS, Ferreira MC. Classification of cleft lip and cleft palate. Suggested changes. Rev Hosp Clin Fac Med Sao Paulo. 1972;27(1):5–6.

    CAS  PubMed  Google Scholar 

  • Sun M, Wang YQ, Li HD, Wu D, Yin NB, Song T. “Three Subunit” classification of lesser-form cleft lip and muscle analysis and reconstruction of these subunits based on the microanatomic structures of muscles in the normal upper lip. J Craniofac Surg. 2019;30(6):1790–3. https://doi.org/10.1097/SCS.0000000000005490.

    Article  PubMed  Google Scholar 

  • Suzuki S, Marazita ML, Cooper ME, et al. Mutations in BMP4 are associated with subepithelial, microform, and overt cleft lip. Am J Hum Genet. 2009;84:406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Taira T, Sawada M, Matsumoto A, Yamakawi Y, Kurokawa M, Isshiki N, Hanawa T, Kawano M. Assessment of palatal fistula repair using a conchal cartilage graft. Studia Phonologica. 1992;26:42–8.

    Google Scholar 

  • Tolarová MM, Cervenka J. Classification and birth prevalence of orofacial clefts. Am J Med Genet. 1998;75(2):126–37.

    Article  PubMed  Google Scholar 

  • Veau V. Division palantine. Paris: Masson et Cie; 1931.

    Google Scholar 

  • Vermeij-Keers C, Rozendaal AM, Luijsterburg AJM, et al. Subphenotyping and classification of cleft lip and alveolus in adult unoperated patients: a new embryological approach. Cleft Palate Craniofac J. 2018;55(9):1267–76. https://doi.org/10.1177/1055665618767106.

    Article  PubMed  Google Scholar 

  • Vieira AR, McHenry TG, Daack-Hirsch S, Murray JC, Marazita ML. A genome wide linkage scan for cleft lip and palate and dental anomalies. Am J Med Genet A. 2008;146A(11):1406–13.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vilar-Sancho B. A proposed new international classification of congenital cleft lip and cleft palate. Plast Reconstr Surg Transpl Bull. 1962;30:263–6.

    Article  CAS  Google Scholar 

  • Wang KH, Heike CL, Clarkson MD, Mejino JL, Brinkley JF, Tse RW, Birgfeld CB, Fitzsimons DA, Cox TC. Evaluation and integration of disparate classification systems for clefts of the lip. Front Physiol. 2014a;5:1–11.

    Article  Google Scholar 

  • Wang BC, Hakimi M, Martin MC. Use of two cleft lip and palate classification systems by nonsubspecialized health care providers. Cleft Palate Craniofac J. 2014b;51(5):540–3. https://doi.org/10.1597/12-192.

    Article  PubMed  Google Scholar 

  • Weinberg SM, Maher BS, Marazita ML. Parental craniofacial morphology in cleft lip with or without cleft palate as determined by cephalometry: a meta-analysis. Orthod Craniofacial Res. 2006a;9(1):18–30.

    Article  CAS  Google Scholar 

  • Weinberg SM, Neiswanger K, Martin R, et al. The Pittsburgh oral-facial cleft study: expanding the cleft phenotype. Background and justification. Cleft Palate Craniofac J. 2006b;43:7.

    Article  PubMed  Google Scholar 

  • Weinberg SM, Brandon CA, McHenry TH, et al. Rethinking isolated cleft palate: evidence of occult lip defects in a subset of cases. Am J Med Genet A. 2008a;146A:1670.

    Article  PubMed  Google Scholar 

  • Weinberg SM, Neiswanger K, Richtsmeier JT, Maher BS, Mooney MP, Siegel MI, Marazita ML. Three-dimensional morphometric analysis of craniofacial shape in the unaffected relatives of individuals with nonsyndromic orofacial clefts: a possible marker for genetic susceptibility. Am J Med Genet A. 2008b;146A(4):409–20.

    Article  PubMed  Google Scholar 

  • Weinberg S, Naidoo SD, Bardi KM, Brandon CA, Neiswanger K, Resick JM, Martin RA, Marazita ML. Face shape of unaffected parents with cleft affected offspring: combining three-dimensional surface imaging and geometric morphometrics. Orthod Craniofacial Res. 2009;12(4):271–81.

    Article  CAS  Google Scholar 

  • Weinberg SM, Parsons TE, Fogel MR, Walter CP, Conrad AL, Nopoulos P. Corpus callosum shape is altered in individuals with nonsyndromic cleft lip and palate. Am J Med Genet A. 2013;161(5):1002–7.

    Article  Google Scholar 

  • Yuzuriha S, Mulliken JB. Minor-form, microform, and mini-microform cleft lip: anatomical features, operative techniques, and revisions. Plast Reconstr Surg. 2008;122(5):1485–93. https://doi.org/10.1097/PRS.0b013e31818820bc.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rafael Denadai .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Denadai, R., Lo, LJ. (2022). Classifying the Wide Clinical Spectrum of Cleft Lip and Palate. In: Denadai, R., Lo, LJ. (eds) Current Concept in Cleft Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-19-3163-5_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-3163-5_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-3162-8

  • Online ISBN: 978-981-19-3163-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics