CLEFT LIP & CLEFT PALATE

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 body’s 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 child’s 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