New diagram for cleft lip and palate description: the clock diagram

The current classification diagrams for cleft lip and palate are descriptions of the components involved in the cleft, but they do not consider in detail the severity of distortion. We sought to establish a new diagram (the Clock Diagram) for cleft lip and palate, which describes the pathology according to the severity of distortion of the nose, lip, and primary and secondary palate, and to apply this classification scheme toward treatment selection.

The method is based on surgical results obtained from 1043 cleft lip and palate patients operated by the author between 1996 and 2007, under the protocol based on our classification. To further illustrate the classification and diagram method, two types of clefts are described, using the proposed diagram and compared with Kernahan's diagram.

This new diagram describes the cleft's severity using terminology from our clinic's classification of cleft severity. In comparison with Kernahan's diagram, the Clock Diagram more effectively demonstrates a cleft's severity. I have observed a higher incidence of lip and palate revision in severe clefts.

The Outreach Program Lima Clock Diagram classifies the severity of the cleft and affords an individualized description of cleft morphology. I have observed a direct relation between cleft severity and the number of poor outcomes in our patients.