CLEFT LIP & CLEFT PALATE

Presentor
Ms. Jeewan Jyoti.

OBJECTIVES
At the end of the teaching students will be
able to acquire the knowledeg regarding
the cleft lip and cleft palate and will be
able to provide care to the children
suffering from the cleft lip and cleft palate.

INTRODUCTION
Cleft is a fissure or opening a gap
It is the non-fusion of the bodys natural structures that
form before birth

Cleft lip (cheiloschisis) and cleft palate (palatoschisis)

are birth defects, that affect the upper lip and roof of
the mouth, in which there is an opening in the lip
and/or palate that is caused by incomplete
development during early fetal formation

DEFINITION
Cleft Lip (Cheiloschisis): It is defined as a congenital anomaly
in which there is presence of a fissure at upper lip
which occurs due to failure of fusion of the maxillary
and median nasal processes
Cleft Palate (Palatoschisis): It is defined as a congenital
anomaly in which there is a fissure at roof of the mouth
which occurs due to failure of fusion of the lateral
palatine processes, the nasal septum and the median
palatine processes.

INCIDENCE RATE
1 in 665 children
Cleft lip in

Cleft palate in

CAUSES

Genetic factor
Maternal factors
Environmental factors
Teratogenic drugs
Family history

TYPES OF CLEFT LIP & CLEFT PALATE

Cleft lip without a cleft palate

Cleft palate without a cleft lip
Cleft lip and cleft palate together

Cont.
Partial or incomplete cleft
Complete cleft
*Unilateral complete cleft
* Bilateral complete cleft

PATHOPHYSIOLOGY

The embryological development of the upper lip and nose involves

fusion of the 5 major facial prominences, occurring between the 3rd
and 8th week of gestation, with lip development between the 3rd and
7th weeks, and palate development between the 5th and 12th weeks.

A cleft lip is formed when normal development is interrupted before

7th week of gestation. The degree of clefting can vary

Deformational cleft lip is seen when failure of fusion of the maxillary

and median nasal processes occurs manifested in the form of a
fissure in the lip

PATHOPHYSIOLOGY

Isolated cleft palate: the development of the palate involves fusion of

the lateral palatal shelves and nasal septum in an anteroposterior
direction from the incisive foramen to the uvula between the 5th and
12th weeks of gestation

A cleft palate is formed when normal palatal development is

interrupted before the 12th week of gestation. The degree of clefting
can range from a complete isolated cleft palate to a bifid uvula.

Deformational cleft palate is seen in Pierre Robin sequence, where a

small mandible (micrognathia) limits the space for the tongue, and
the prominent tongue (glossoptosis) mechanically obstructs palatal
fusion, leading to the classic triad of micrognathia, glossoptosis, and
an isolated cleft palate.

SIGN AND SYMPTOMS

Feeding problems
Failure to gain weight
Flow of milk through nasal passages during
feeding
Poor growth
Repeated ear infections
Speech difficulties
Dental Abnormalities
Speech Difficulties
Middle Ear Fluid Buildup and Hearing Loss

INVESTIGATION
Prenatal diagnosis
Initial assessment

MANAGEMENT

MEDICAL MANAGEMENT

Assessment of the child

Reassurance to parents
Feeding the child
Airway clearance
Infection prevention

SURGICAL MANAGEMENT
Chieloplasty
Platatoplasty

NURSING
MANAGEMENT

Nursing Assessment
Carefully perform the head to toe assessment of
the child immediately after the birth
Assess the location and extent of the defect by
using gloved finger.
Assess the feeding pattern of the child.
Assess the need for the surgical correction.
Assess the parents understanding of the defect and
the need for the surgery.

NURSING DIAGNOSIS

Altered nutrition less than body requirements

Risk for infection.
Risk for aspiration
Ineffective breathing pattern.
Altered family process
Impaired tissue integrity

PREOPERATIVE NURSING
MANAGEMENT

Feeding the child: steril breast feed, appropriate nipple, burp.

Provide right position

Airway clearance

Reassurance to parents.

Hygienic care

Timings Follow rule of ten for surgery

Immunization complete all immunization accordingly before surgery.

Thumb sucking discourage thumb sucking and prevent it.

Encourage the child to lie on its back for practice regarding post-operative
positioning.

Monitor the nutritional status of the child.

POST OPERATIVE NURSING MANAGEMENT

Assess vital signs of child regularly

Reposition the infant every 2 hourly
Clean the suture line with the saline solution and a cotton tipped applicator
Anticipate the childs need to decrease his crying
Give general post-operative care to the child
Provide side-lying position to drain secretions and prevent aspiration
Protection of surgical sutured
Provide supine position
Maintain protective device on sutures
Provide elbow restrain
Assess the child for irritability, loss of appetite and restlessness every 2 hrs of the
surgery
Maintain aseptic dressing with precautions
Avoid injury to mouth of the child
Feeding with medicine dropper
Parental counseling is an important thing and advise about care, feeding and follow
up etc

COMPLICATIONS

Feeding problems
Ear infections and hearing loss
Speech and language delay
Dental problems

SUMMARIZATION

Definition
Etiology
Classification
Pathophysiology
Clinical manifestation
Diagnostic evaluation
Management