A Review of Classification Systems for Cleftlip and Palate Patients Ii. Embryological Classifications

The second and final article of this series describes the embryological classifications of cleft lip and palate patients, their usage and deficiencies. Correspondence: Dr. Syed Nasir Shah Head Department of Prosthodontics Sardar Begum Dental College and Hospital, Gandhara University, Academy Town, Peshawar, Pakistan E-mail: [email protected] JKCD June 2012, Vol. 2, No. 2 87 A review of classification systems for cleftlip.................. • Areas 3 and 6 – Primary Palate (It represents the fusion line between the primary and secondary palate and lies anterior to the incisive foramen). • Areas 7 and 8 Hard palate (It represents the fusion line between palatine shelves of the hard palate posterior to the incisive foramen). • Area 9 Soft palate The small circle represents incisive papilla. In order to show the cleft, stippling of the appropriate areas is done on the above diagram. EXAMPLES: 1. Clefts of the soft palate will be represented by the following diagram. Fig. 1: Kernahan striped Y classification Fig. 2: Modified striped-Y Elshay classification • Triangle 1 represents the fusion line between the maxillary prominence and medial nasal prominence at nostril floor level on right side while triangle 5 represents the fusion line between the maxillary prominence and medial nasal prominence on the left side at the nostril floor level. • Square 2 represents the fusion line between the maxillary prominence and medial nasal prominence at upper lip level on the right side while square 6 represents the fusion line between the maxillary prominence and medial nasal prominence at upper lip level on the left side. • Square 3 represents the right alveolus while square 7 represents the left alveolus (fusion line between the maxillary prominence and intermaxillary segment). • Square 4 and 8 represents the fusion line between primary and secondary hard palate (which lies anterior to the incisive foramen) on the right and left side respectively. • Squares 9 and 10 represents the fusion line between palatine shelves of hard palate and lies posterior to the incisive foramen. • Square 11 represents the soft palate. • Circle 12 represents the posterior pharyngeal wall. • Circle 13 represents the pre-maxilla. This classification has following advantages over original striped-Y. 1. It gives information about the degree of cleft lip. For example, if there is unilateral complete cleft lip(involving lip and nostril floor) stippling will include the triangle and square on that side (incase of bilateral cleft lip, the respective areas 2. Left Cleft lip will be represented by the following diagram. 4. MODIFIED STRIPED-Y ELSAHY CLASSIFICATION: Elsahy modified Kernahan Striped –Y classification in 1973 by recording more details4 as shown in Figure 2 1