New classification system proposed for infants with nasal deformity in cleft lip and palate

A proposed classification system appears highly accurate in evaluating nasal deformities in infants with cleft lip and/or palate (CLP), reports a study in the May/June issue of The Journal of Craniofacial Surgery.

Cleft lip and/or palate is one of the most common congenital deformities. Many infants with CLP have accompanying nasal deformities, but these are generally not included in standard CLP classification systems. Deformities of the nose may seem like a secondary concern at birth, but often become more prominent over time.

If a person cannot speak or hear due to nasal deformities secondary to orofacial clefts, it can significantly impact their ability to communicate. Effective communication skills are essential for achieving social acceptance and leading a normal life.

In their study, Dr. Mejia and colleagues report the development and initial evaluation of a new standardized tool to guide evaluation of CLP-related nasal deformities. The proposed classification focuses on factors readily assessed by clinicians treating infants with facial deformities—for example, symmetry of the septum, projection of the nasal tip, and the shape of the nostrils. Users rate each feature as moderate to severe, guided by patient photographs. The proposed system includes separate classifications for unilateral (one side) and bilateral (both sides) clefts.

‘Excellent’ agreement in classifying CLP-related nasal deformities

The findings “demonstrate[d] strong consistency among specialists applying the classification system to photographs,” the researchers write. Survey results suggested “excellent” agreement between the panel members’ ratings of the severity of nasal deformities. Although ICC values were higher for unilateral versus bilateral clefts (0.816 versus 0.743), both sets of ratings showed high reliability.

The proposed classification system provides a user-friendly tool for evaluating nasal deformities in infants with CLP. “Prioritizing easily identifiable features bridges the gap between novice and experienced clinicians, promoting consistent diagnosis and treatment planning for CLP patients,” Dr. Mejia and colleagues write. Their article includes figures illustrating the proposed classification system and explaining its use.

An important next step will be assessing the new tool’s use in evaluating improvement of nasal deformities after cleft repair surgery and orthodontic treatment. Dr. Mejia and co-authors conclude, “By tracking changes in nasal classification scores over time, clinicians can evaluate the efficacy of different treatment approaches and identify potential areas for refinement.”