Cleft LIP and Cleft PALATE

Cleft LIP/Cleft PALATE

a gastrointestinal disorder that result of faulty embryonic development.


Cleft lip more frequent among males Cleft palate- more frequent among females Both more common among males

ETIOLOGY:
Primarily genetic; thus a mother who has had a child with this deformity is more likely to have another child with the same deformity. Chromosomal abnormalities Teratogenic effects b. Types: Unilateral Bilateral Midline (Rare)

Associated Problems: Feeding a child is not able to maintain close suction of the nipple Upper Respiratory Tract Infection- because they breath through the mouth Ear Infection because the pharyngeal opening of the Eustachian tube is in an abnormal position Speech Defects Dental Malformation Body Image

Definitive Treatment: Cleft LIP Cheiloplasty done as early as possible using the rule of 10 At least 10 weeks old Weighing at least 10 pounds Having at least 10 Gms. Hemoglobin Cleft Plate Plalatoplasty ; done very early but not earlier than 10-12 months because it may harm the tooth buds not too late because palate may become too rigid and the child might develop undesirable speech pattern

Velopharyngeal flap operation- at age 8-9 years To revise previous repair To correct nose deformities To reconstruct the nasopharynx for speech improvement

Preoperative Nursing Care Provide support for the parents Parents may have difficulty loving the infant. And responding warmly to him; encourage to verbalize guilt, fears and anger Feeding Use soft, regular ,cross-cut nipple Burp more frequently Do not feed lying down ( sitting or semi-sitting position) Do not confine lying on back for a long period of time to prevent URTI and ear infection Give small amount of water after feeding to rinse the mouth Prevent cracked lips since the baby breaths through the mouth

Postoperative Cheiloplasty Complication RESPIRATORY DISTRESS during the first 48 hours Increased respiratory secretions Difficulty adjusting to smaller airway Swelling of tongue, mouth and nostrils

Nursing Care Minimize carrying Put inside a mist tent to liquefy respiratory secretions Can lie only on his back (NEVER ON ABDOMEN) Elbow restrains at all times to prevent him from putting his hands or other object to his mouth. A Logan s bow is taped after surgery to protect the suture line After feeding, suture line is cleansed with a cotton tipped applicator dipped in a half- strength hydrogen peroxide I order to prevent crust which could cause uneven healing and infection leaving ugly scars.

Postoperative Palatoplasty Complication hemorrhage Position the child on abdomen to facilitate drainage of secretions because suction is never done Use of mist tent is recommended Elbow restrained are applied Sucking, blowing, talking, laughing, or putting object into the mouth is not allowed Feedings oPaper cups are used. Never spoon, fork, knife, straw or glass oRinse mouth with sterile water oResume feedings after 3-4 weeks after repair oGive small frequent feedings