New classification system for nasal deformity in cleft lip and palate reported
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. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"This new tool offers a reliable and practice tool for categorizing the severity of nasal deformities in CLP patients," comments lead author Martha Mejia, DDS, of Nicklaus Children's Health System, Miami. "With ongoing evaluation, it may promote more consistent diagnosis, individualized treatment planning, and standardized approaches to enhance outcomes for infants with CLP."
Standardized approach to evaluating CLP-related nasal deformities
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.
To evaluate its accuracy, the researchers sent the classification system and instructions to an international panel of plastic surgeons and orthodontists with varying levels of experience in managing infants with CLP. Each clinician was sent a random sample of close-up patient photographs and asked to rate each factor as mild to severe, based on their understanding of the classification system. The reliability of the experts' ratings was compared using a statistical technique called intraclass correlation coefficient (ICC).
'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 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 coauthors 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."
Reference:
Mejia M, Bernal I, Cordero JP, Bercu C, Policherla R, Steinberg JP. A Proposed Nasal Deformity Classification System for Infants With Cleft Lip and Palate. J Craniofac Surg. 2025 May 27. doi: 10.1097/SCS.0000000000011151.
