Saying It Precisely, How Surgeons Classify a Cleft
How do surgeons classify a precisely enough that the label alone tells another team exactly what they are dealing with?
💡 A good turns a paragraph of description into one shareable label any team can read.
Prerequisite check
- A is a gap left where tissues that should have joined during development did not (a failure of ).
- In a lip the ring is interrupted and its fibers run up the cleft margins instead of crossing the .
What you will learn
Goal: Use the Veau, LAHSHAL, and systems to classify a , and place Mateo as a complete left cleft of lip, , and ().
- An international survey of 197 providers found 18 systems in use, with ICD-10 (35.5%), LAHSHAL (34.0%), Veau (32.5%), and the striped-Y (22.8%) most common.
- Veau sorts clefts into four groups by which structures are clefted, divided at the , and acts as a rough severity proxy.
- LAHSHAL is a seven-letter string (Lip--Hard-Soft-Hard-Alveolus-Lip) that records side, extent, and completeness at once; capitals mean complete, lowercase mean incomplete.
- Mateo's is a complete left cleft of lip, , and , which is .
Model: Three ways to label the same cleft
A survey asked 197 providers from 166 centers in 61 countries which classification systems they use. It found 18 different systems in use, but a few dominated: ICD-10 (35.5 percent), LAHSHAL (34.0 percent), Veau (32.5 percent), and Kernahan's striped-Y (22.8 percent). Providers said the most essential thing a system must capture is the cleft's , and their most common complaint was that their system did not describe severity and extent precisely enough.
Veau (four severity groups) uses the as the dividing line: I, soft only; II, soft and back to the incisive foramen; III, complete of lip, , and palate; IV, complete cleft. LAHSHAL is a string of seven letters that march from the patient's right to left (Lip, Alveolus, Hard palate, Soft palate, Hard palate, Alveolus, Lip), with the soft palate central. A capital letter means a of that structure, lowercase means incomplete, and a dot means intact, so one short string records side, extent, and completeness. The is a Y-shaped box diagram you shade for the clefted structures, doing the same job as a quick picture.
Explore (work the model before reading on)
- How many different classification systems were found in use among providers?
- In Veau, which class is a complete of lip, , and ?
- In LAHSHAL, what is the difference between a capital letter and a lowercase letter?
- Recall Mateo: his runs through the lip, , and whole on the left only, right side intact. Which single fits him?
- Predict: if you only had the label "," what could you still NOT tell that LAHSHAL would tell you?
Guided notes
Why classify
- Precise classification matters because it guides treatment planning and lets centers ____ their results.
Veau and LAHSHAL
- Veau divides clefts at the ____ foramen into four groups and works as a rough severity proxy.
- LAHSHAL uses ____ letters for complete clefts and lowercase for incomplete, so it captures side, extent, and completeness.
- Veau's weakness is that it does not record ____ (which side).
Placing Mateo
- Mateo's complete left of lip, , and is Veau ____.
Reading the Research
- Skim the title and abstract first to get the gist.
- Circle the one sentence that states the main claim.
- Box the evidence the authors give for that claim.
- Mark one sentence that confuses you, and move on.
Vocabulary (the same words your classes use)
Track your progress today
Check these off as you work through the lesson, then submit. This tells Mr. Mendoza how you're doing so he can help the class. It does not replace turning in your producible.
Use the code Mr. Mendoza gave you, not your name. Saved on this device.
- Read the Model and answered the Explore questions.
- Filled in the guided notes in my own words.
- Defined the new vocabulary with an example.
- Built the producible: Classify Mateo three ways and write it into his chart: (1) Veau class with a one-sentence justification, (2) a LAHSHAL string filling the seven positions right-to-left (capitals for complete, a dot for intact, central soft palate clefted), and (3) a shaded striped-Y. Then write one sentence to a surgeon in another city using only your three labels.
- Wrote my Claim, Evidence, and Reasoning exit ticket.
Exit ticket (Claim, Evidence, Reasoning)
- Claim: Mateo's is a complete left cleft of lip, , and , which is Veau ____.
- Evidence: State which structures are clefted and on which side, and show how that maps to the .
- Reasoning: Explain why a single precise label is more useful to a worldwide team than a paragraph of description.
| Criterion | Proficient | Developing | Beginning |
|---|---|---|---|
| Complete | Every required part of the artifact is present and filled in. | Most parts are present, but one is missing or left blank. | Several parts are missing. |
| Accurate | The science and data are correct and match the evidence. | Mostly correct, with a small factual slip. | Key science or data is wrong. |
| Scientific reasoning (CER) | States a claim, backs it with specific evidence, and explains the reasoning. | Has a claim and evidence, but the reasoning is thin or missing. | Gives an answer with no evidence or reasoning. |
| Professional communication | Clear, organized, and labeled the way a clinician or scientist would write it. | Readable but disorganized or missing labels. | Hard to follow. |
| Submitted | Turned in the right way (Schoology for routine work) and confirmed. | Turned in, but in the wrong place or unconfirmed. | Not turned in. |
- CompleteProficient: Nothing is left blank: the model fills every part of "Classify Mateo three ways and write it into his chart: (1) Veau class with a one-sentence justification, (2) a LAHSHAL string filling the seven positions right-to-left (capitals for complete, a dot for intact, central soft palate clefted), and (3) a shaded striped-Y. Then write one sentence to a surgeon in another city using only your three labels.".
- AccurateProficient: Every number and claim matches the case evidence.
- Scientific reasoning (CER)Proficient: It names a claim, cites the specific evidence, and explains the reasoning, not just the answer.
- Professional communicationProficient: It is organized and labeled like a real chart note.
- SubmittedProficient: It would be turned in on Schoology and confirmed.
Where this leads: careers
What's next: We can now name Mateo's precisely: , a complete left CL/P. But his is only one shape out of many. Some clefts are on both sides, some stop short of the nostril, and some hide under intact skin. What makes one cleft different from another, and what is the full spectrum of forms? We chase that next time.