OBJECTIVETo evaluate the five-digit numerical recording system (LAPAL system) for classification of cleft lip and palate.

METHODSFourteen young doctors took part in the study after receiving one-hour instruction twice for the LAPAL system. Photographs of 200 cases of untreated cleft lip and palate were used for the evaluation. The diagnostic codes of the patient were recorded and compared with the teacher's standard diagnosis. The basic criterion of the LAPAL system was that the clefts were arranged in five anatomical components in order of right lip (L), right alveolus and primary palate (A), secondary palate (P), left alveolus and primary palate (A), and left lip (L). The degrees of the cleft severity were recorded with Arabic number 0 for the intact, 1 for the subcutaneous or submucous cleft, 2 for clefts smaller than half of a component, 3 for clefts larger than half of a component, 4 for complete clefts.

RESULTSThe rate of the diagnostic coincidence was 88% (2475/2800) totally. The higher coincidence appeared in degree 4 of cleft lip and in degree 4 of cleft alveolar and cleft primary palate as 99% (707/714) and 100% (546/546), respectively. The lower coincidence appeared in degree 2 and degree 3 of clefts of the alveolus and primary palate as 70% (98/140) and 82% (103/126), respectively. Among the 17 types of possible cleft combination, 14 types were found in the present study.

CONCLUSIONSThe LAPAL system is easily understood and grasped in a short time. Clefts on the border of adjoin degrees may cause confusion in diagnosis. More training or simplified modification is suggested.