Learnability of the LAHSHAL Classification for Oral Clefts: Results of an International Webinar

INTRODUCTION: Orofacial clefts are common congenital anomalies with significant physical, emotional, and social challenges. Classification systems like LAHSHAL aim to standardize cleft descriptions, enhancing clinical communication and research. Despite its adoption by the European Reference Network on Craniofacial Anomalies (ERN Cranio), the system's familiarity and learnability among health care providers remain uncertain.

METHODS: This study assessed the learnability of LAHSHAL through pre-webinar and post-webinar surveys with 29 cleft care specialists from 11 countries. Participants classified 10 cleft cases using LAHSHAL before and after an educational webinar. Inter-rater agreement was evaluated using Fleiss Kappa.

RESULTS: Pre-webinar inter-rater agreement was very low (κ=-0.015), reflecting inconsistent system use and limited prior experience, as 60% of participants had never used it. Post-webinar agreement improved significantly (κ=0.217; P<0.001), and all participants applied LAHSHAL classifications. However, variability persisted, particularly for complex clefts like those involving Simonart's bands.

DISCUSSION: The webinar improved familiarity and consistency in LAHSHAL usage, emphasizing the value of educational interventions. Nonetheless, post-webinar variability highlights the need for further training, especially for atypical cleft presentations. Although LAHSHAL shows potential for advancing cleft classification and research, improved guidelines and integration with systems like ICD-10 are required.

CONCLUSION: The LAHSHAL system is a promising classification tool for clefts, but variability in its application indicates the need for ongoing training and refinement to ensure accurate, widespread use.