Rare craniofacial clefts: a surgical classification.

The Tessier classification is the current standard for identifying and reporting rare craniofacial clefts. This numerically based system describes 16 different primary clefts, with additional possible combinations that can significantly raise the total number of potentially describable clefts. Problems with this system include a complexity that requires most surgeons to consult a diagram to describe the location of a cleft. In addition, the Tessier classification can include conditions that may not actually involve a true cleft such as frontonasal dysplasia, Treacher Collins syndrome, and craniofacial microsomia. A surgically based classification is proposed that includes only true clefts (eliminating hyperplasias, hypoplasias, and aplasias) and classifies these rare anomalies into 1 of 4 types based on anatomic regions: midline, median, orbital, and lateral. This simplified classification for craniofacial clefts, which is based on a different surgical paradigm appropriate to each regional location, enables surgeons to describe an observed cleft in such a way that others can easily visualize the location and have a starting point for formulating treatment decisions.