A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Secondary cleft lip (CL) deformities are frequent challenges in cleft care.
• Existing classification systems for residual CL deformities after primary repair have limitations.
• A need exists for a comprehensive and practical classification system.

Purpose of the Study:

• To validate existing classification systems for secondary CL deformities.
• To introduce a new subtype, Type V Revision, to the classification system.
• To improve the categorization and management of residual CL deformities.

Main Methods:

• Longitudinal retrospective analysis of 269 patients with residual CL deformities.
• Data collected from 35 outreach programs across 4 countries (2015-2023).
• Patients classified into 5 types, with a new Type V Revision introduced; exclusion of syndromic patients.

Main Results:

• A total of 269 patients underwent revision surgery, with distribution across types I-V.
• Surgical complexity and average surgical time increased progressively from Type I to Type V revisions.
• Substantial congruence was observed between preoperative and postoperative revision type classifications.

Conclusions:

• The proposed classification system, including the new Type V Revision, effectively categorizes secondary CL deformities.
• This system simplifies the management of residual CL defects, reducing patient and provider burden.
• The classification demonstrates significant congruence, supporting its clinical utility in cleft lip repair outcomes.