CLEFT LIP AND

CLEFT PALATE
 COMPARISON
FEATURES CLEFT LIP CLEFT PALATE

Incidence Common among males 1/1000 Common among females

1/2500

Genetic Multifactoral Multifactoral

Description is an abnormality in which the occurs when the roof of the

lip does not completely form mouth does not completely
during fetal development. close, leaving an opening that
can extend into the nasal
cavity.

Pathophysiology result when tissues fail to result when tissues fail to

fuse fuse
Surgical repair Cheiloplasty (logan bow) Palatoplasty
FEATURES CLEFT LIP CLEFT PALATE
Preoperative care usually occurs at 1 to 3 months usually performed between 6
of age and 18 months of age
Position post op Supine (on his back) Prone (on her abdomen)
-to avoid injury of the -to facilitate drainage of
operative site mucus and blood
Feeding post op No sucking No sucking
Use Breck feeder/rubber Use wide-bowl spoon or paper
tipped medicine dropper cup.
Nursing care post op Elbow restraint Same
Lessen crying(may cause stress
on suture line)
Croup/mist tent (to prevent
respiratory distress and to
keep secretions moist)
Long term concern Bonding attachment Defective speech, refer to
Social adjustment speech therapist
Abnormal dentition;
Refer to orthodontist
Hearing loss; refer to
audiologist
Possible Complication feeding difficulties feeding difficulties
ear infections and hearing loss ear infections and hearing loss
speech and language delay speech and language delay
dental problems dental problems
 Description
1. Cleft lip (cheiloschisis) is a congenital anomaly
that occurs at a rate of 1 in 800 births.
a. If the cleft does not affect the palate structure
of the mouth it is referred to as cleft lip.
b. Cleft lip is formed in the top of the lip as either a
small gap or an indentation in the lip (partial or
incomplete cleft) or it continues into the nose
(complete cleft)
c. Cleft lip can be unilateral or bilateral.
d. It is due to the failure of fusion of the
maxillary and medial nasal processes
(formation of the primary palate).
Cleft palate (palatoschisis) is a congenital anomaly
that occurs in approximately 1 of every 2000
births, and it is more common in boys than girls.
a. It is a condition in which the two plates of the
skull that form the hard palate (roof of the
mouth) are not completely joined.
b. It ranges in severity from soft palate
involvement alone to a defect including the hard
palate and portions of the maxilla.
c. Cleft palate may or may not be associated with
cleft lip.
 Etiology
1. Many factors are associated with the
development of cleft lip and cleft palate, and
cleft lip with or without cleft palate are
developmentally and genetically different
from isolated cleft palate.
2. Most cases appear to be consistent with the
concept of multifactorial inheritance as
evidenced by an increase incidence in
relatives and monozygotic twins
 Pathophysiology
1.During embryonic development the lateral
and medial tissues forming the upper lip
palates fuse between weeks 7 and 8 of
gestation; the palatal tissues forming the hard
and soft palates fuse between weeks 7 and 12
gestation.
2. Cleft lip and cleft palate result when these
tissues fail to fuse.
Assessment findings
1. Clinical manifestations
a. Cleft lip and cleft palate are readily apparent at
birth. Careful physical assessment should be
performed to rule out other midline birth
defects.
b. Cleft lip and cleft palate appear as incomplete or
complete defects, and may be unilateral or
bilateral.
2. Laboratory and diagnostic study findings.
Obstetric ultrasound will reveal cleft lip while the
infant is in utero.
Nursing management
1. Assess for problems with feeding, breathing
parental bonding, and speech.
2. Ensure adequate nutrition and prevent
aspiration.
a. Provide special nipples or feeding devices (eg,
soft pliable bottle with soft nipple with
enlarged opening) for a child unable to suck
adequately on standard nipples.
b. Hold the child in a semi upright position;
direct the formula away from the cleft and
toward the side and back of the mouth to
prevent aspiration.
c. Feed the infant slowly and burp frequently to
prevent excessive swallowing of air and
regurgitation.
d. Stimulate sucking by gently rubbing the nipple
against the lower lip.
Support the infant’s and parents’ emotional
and social adjustment.
a. Help facilitate the family’s acceptance of the
infant by encouraging the parents to express
their feelings and concerns and by conveying
an attitude of acceptance toward the infant.
b. Emphasize the infant’s positive aspects and
express optimism regarding surgical
correction.
Provide preoperative care.
a. Depending in the defect and the child’s general
condition, surgical correction of the cleft lip
usually occurs at 1 to 3 months of age; repair of
the cleft palate is usually performed between 6
and 18 months of age. Repair of the cleft palate
may require several stages of surgery as the child
grows.
b. Early correction of cleft lip enables more normal
sucking patterns and facilitates bonding. Early
correction of cleft palate enables development of
more normal speech patterns.
Delayed closure or large defects may require the
use of orthodontic appliances.
d. The responsibilities of the nurse are to:
1. Reinforce the physician’s explanation of surgical
procedures.
2. Provide mouth care to prevent infection.

Provide postoperative care.

a. Assess airway patency and vital signs; observe for
edema and respiratory distress.
b. Use a mist tent, if prescribed, to minimize
edema, liquefy secretions, and minimize distress.
Position the child with cleft lip on her back, in an infant seat, or propped on a
side to avoid injury to the operative site; position the child with a cleft
palate on the abdomen to facilities drainage.
d. Clean the suture line and apply an antibacterial ointment as prescribed to
prevent infection and scarring. Monitor the site for signs of infection.
e. Use elbow restraints to maintain suture line integrity. Remove them every
2 hours for skin care and range-of-motion exercises.
f. Feed the infant with a rubber-tipped medicine dropper, bulb syringe, Breck
feeder, or soft bottle-nipples, as prescribed, to help preserve suture
integrity. For older children, diet progresses from clear fluids; they should
not use straws or sharp objects.
g. Attempt to keep the child from putting tongue up to palate sutures.
h. Manage pain by administering analgesic as prescribed.