Classification of the cleft deformity

The deformity in clefts of the lip and palate can range widely in severity and extent, rendering attempts to classify them into a limited set of patterns somewhat impractical. The various terms used to describe palatal clefts are defined in Table 16.2.

Clefts of the lip may be barely noticeable, with minimal surface abnormalities or asymmetry of vertical height indicating an underlying abnormality of muscle anatomy, a 'forme fruste' or microform cleft lip. The deformity can range from this to a complete cleft of the lip, alveolus, primary palate and secondary palate.

Clefts of the palate alone may similarly manifest a wide range of severity. There may be no surface or visible evidence of clefting, but abnormalities of soft palatal function only displayed by features suggestive of velopharyngeal incompetence. This occult submucous cleft may occur in an otherwise intact palate with minimal surface evidence of an underlying abnormality of muscle anatomy. The clinical features of submucous cleft deformity are listed in Table 16.3.

Although clefts of the lip and primary palate associated with clefts of the soft palate and/or the posterior hard palate with an intervening bridge of intact hard palate are rare, they have been described. Similarly, clefts of the palate alone involving the bony palate may be unilateral with partial or complete attachment of the vomer to one side.

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