Classification of Cleft Lip and Palate

Classification of Cleft Lip and Palate
	Type 1	Type 2	Type 3a	Type 3b	Type 4	Type 5
	Cleft lip without cleft palate	Unilateral cleft lip and palate	Bilateral cleft lip and palate + Premaxillary protrusion	Bilateral cleft lip and palate + No premaxillary protrusion	Midline cleft lip and palate (premaxillary agenesis).	Cleft associated with amniotic bands or limb-body wall complex.
Pathogenesis	Normally formed palate but incomplete fusion of the lip.	Unilateral incomplete fusion of lip + variable degree of incomplete fusion of primary palate with secondary palate	Failure of fusion of primary with secondary palate.	Absence of the primary bone plate.	Absence of the primary plate and overlying lip.	Aberrant fibrous bands that produce bizarre slash defects
Chromosomal Abnormalities	Usually normal Karyotype	+/- 20%	30%	30%	> 50% (over half are trisomies esp trisomy 13	5%
Outcome	Favorable	Variable – dependent on whether other anomalies are present			Usually fatal due to concurrent anomalies	Usually fatal
Ultrasound	Only seen on coronal or transverse views Not seen on midsagittal views (as they are unilateral lesions). Lesion in Type 2 is deep and longer than in type 1 and associated with distortion of the nose		Echogenic soft tissue mass protruding from upper lip. Best seen on mid sagittal view	No soft tissue mass Hypoplastic mid-face	Gaping midline cleft Hypoplastic midface	Similar to type 2 but has extra-facial anomalies: * Cranial defects * Limb defects * Abdominal wall defects