CLEFT LIP AND CLEFT PALATE

INTRODUCTION

Cleft lip and cleft palate are

congenital anomalies that
occur as a result of failure of
soft tissue or bony structure
to fuse during embryonic
development. The defects
involve abnormal openings
in the lip and palate that may
occur unilaterally or
bilaterally and are readily
apparent at birth.
Definition

Cleft lip (Cheiloschisis):-

a cleft lip result from failure of fusion of maxillary process
with nose elevation on fontal prominence . the extend of
defect varies from a notch in the lip ( partial or incomplete
cleft )to a large cleft reaching the floor of nose (complete
cleft). cleft lip can occur on one side ya both side
Cleft palate ( Palatoschisis) :-
cleft palate results from failure of fusion of the hard palate
with each other and with the soft palate .cleft palate may be
complete (involving hard and soft palate , possible including
gap in the palate )or incomplete ( a hole in the roof of the
mouth , usually in soft palate )
INCIDENCE AND ETIOLOGY

Cleft lip and cleft palate are facial and oral malformation
that occur in fetus very early in pregnancy , while the baby
is developing inside mothers womb . in most cases , the
cause is unknown .
most physician believe that cleft occur due to a combination
of genetic and environment factors.
pontential causes may be -
 Medication taken by mother during pregnency like
anticonvulsant , chemotherapy
 exposure to viruses or chemical while fetus is developing
in the womb .
 exposure to x ray.
 maternal medical condition like anemia hypoprotenimia
etc.
 maternal intake of alcohole .
 maternal smoking during pregnancy increase the risk of
cleft lip to two times
DIAGNOSTIC EVALUATION

Penatal diagnosis of cleft is at times possible by maternal

USG . after birth a physical examination of the mouth ,
palate and nose confirms the presence of cleft lip or palate
.a gloved finger placed in mouth to feel the defect or visual
examination with a flash light will confirm the diagnosis.
ASSESSMENT

Cleft lip can range from a slight notch to a complete

separation from the floor of the nose.

Cleft palate can include nasal distortion, midline or

bilateral cleft, and variable extension from the uvula and
soft and hard palate.
INTERVENTION

 Assess the ability to suck, swallow, handle normal

secretions, and breathe without distress.
 Assess fluid and calorie intake daily.
 Monitor daily weight.
 Modify feeding techniques; plan to use specialized
feeding techniques, obturators, and special nipples and
feeders.
 Hold the infant in an upright position and direct the
formula to the side and back of the mouth to prevent
aspiration.
 Feed small amounts gradually and burp frequently.
Keep suction equipment and a bulb syringe at the bedside.
 Teach the parents special feeding or suctioning
techniques.
 Teach the parents the ESSR method of feeding— enlarge
the nipple, stimulate the sucking reflex, swallow, rest to
allow the infant to finish swallowing what has been placed
in the mouth.
 Encourage parents to express their feelings about the
disorder.
 Encourage parental bonding with the infant, including
holding the infant and calling the infant by name.
• Closure of a cleft lip defect precedes closure of the cleft
palate and is usually performed by age 3 to 6 months.
• Cleft palate repair is usually performed between 6 and 24
months of age to allow for the palatal changes that occur
with normal growth; a cleft palate is closed as early as
possible to facilitate speech development.
• A child with cleft palate is at risk for developing frequent
otitis media; this can result in hearing loss.
• A multidisciplinary team approach, including audiologists,
orthodontists, plastic surgeons, and occupational and
speech therapists, is taken to address the many needs of
the child.
 a Cleft lip may require one or two surgeries depending on
the severity of defect . common procesdure of repair of
clefrt lip are tennison randall triangular flap (z
plasty)and millards rotational adavancement
techniques
 a cleft palate the initial surgery creates a functional palate
, reduces the chance of fluid entering the middle ears and
help in proper development of teeth and facial bones .
children with a cleft palate may need a bone craft when
they are about 8 years old to children filll in the upper gum
line so that it can support permanent teeth and stablize
upper zaw
Post operative intervenetion

Cleft lip repair -

 Provide lip protection; a metal appliance or adhesive
strips may be taped securely to the cheeks to prevent
trauma to the suture line.
 Avoid positioning the infant on the side of the repair or in
the prone position because these positions can cause
rubbing of the surgical site on the mattress
(position on the back upright and position to prevent airway
obstruction by secretions, blood, or the tongue).
Keep the surgical site clean and dry; after feeding, gently
cleanse the suture line of formula or serosanguineous
drainage with a solution such as normal saline or as
designated by agency procedure.
Apply antibiotic ointment to the site as prescribed.
Elbow restraints should be used to prevent the infant from
injuring or traumatizing the surgical site.
Monitor for signs and symptoms of infection at the
surgical site.
Cleft palate repair
 Feedings are resumed by bottle, breast, or cup per
surgeon preference; some surgeons prescribe the use of
an Asepto syringe for feeding or a soft cup such as a
Sippy cup.
 Oral packing may be secured to the palate (usually
removed in 2 to 3 days).
 Do not allow the child to brush his or her teeth. d. Instruct
the parents to avoid offering hard food items to the child,
such as toast or cookies.
Soft elbow or jacket
restraints may be used
(check agency policies
and procedures) to keep
the child from touching the
repair site; remove
restraints at least every 2
hours (or per agency
procedure) to assess skin
integrity and circulation
and to allow for exercising
the arms.
Avoid the use of oral suction or placing objects in the
mouth such as a tongue depressor, thermometer, straws,
spoons, forks, or pacifiers.
 Provide analgesics for pain as prescribed.
 Instruct the parents in feeding techniques and in the care
of the surgical site.
 Instruct the parents to monitor for signs of infection at the
surgical site, such as redness, swelling, or drainage.
Encourage the parents to hold the child.
Initiate appropriate referrals such as a dental referral and
speech therapy referral