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CLEFT LIP AND CLEFT PALATE
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29088241 Cleft Lip and Cleft Palate

Apr 14, 2018

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Dede Kasilan
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CLEFT LIP

AND CLEFT 

PALATE

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COMPARISONFEATURES CLEFT LIP CLEFT PALATE

Incidence Common among males 1/1000 Common among females1/2500 

Genetic Multifactoral  Multifactoral 

Description is an abnormality in which thelip does not completely form

during fetal development.

occurs when the roof of themouth does not completely

close, leaving an opening that

can extend into the nasal

cavity.

Pathophysiology  result when tissues fail tofuse 

result when tissues fail tofuse 

Surgical repair  Cheiloplasty (logan bow)  Palatoplasty 

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FEATURES CLEFT LIP CLEFT PALATE

Preoperative care  usually occurs at 1 to 3 monthsof age 

usually performed between 6and 18 months of age 

Position post op  Supine (on his back) 

-to avoid injury of theoperative site 

Prone (on her abdomen) 

-to facilitate drainage ofmucus and blood 

Feeding post op  No sucking 

Use Breck feeder/rubbertipped medicine dropper 

No sucking 

Use wide-bowl spoon or papercup. 

Nursing care post op  Elbow restraint 

Lessen crying(may cause stress

on suture line) Croup/mist tent (to preventrespiratory distress and tokeep secretions moist) 

Same 

Long term concern  Bonding attachment 

Social adjustment 

Defective speech, refer tospeech therapist 

Abnormal dentition; 

Refer to orthodontist Hearing loss; refer toaudiologist 

Possible Complication feeding difficulties

ear infections and hearing loss

speech and language delay

dental problems 

feeding difficulties

ear infections and hearing loss

speech and language delay

dental problems 

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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)

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c. Cleft lip can be unilateral or bilateral.

d. It is due to the failure of fusion of themaxillary and medial nasal processes

(formation of the primary palate).

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 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.

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 Etiology 

1. Many factors are associated with thedevelopment of cleft lip and cleft palate, andcleft lip with or without cleft palate are

developmentally and genetically differentfrom isolated cleft palate.

2. Most cases appear to be consistent with theconcept of multifactorial inheritance asevidenced by an increase incidence inrelatives and monozygotic twins

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 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 thesetissues fail to fuse.

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 Assessment findings 

1. Clinical manifestations

a. Cleft lip and cleft palate are readily apparent atbirth. Careful physical assessment should beperformed to rule out other midline birth defects.

b. Cleft lip and cleft palate appear as incomplete orcomplete defects, and may be unilateral orbilateral.

2. Laboratory and diagnostic study findings.Obstetric ultrasound will reveal cleft lip while theinfant is in utero.

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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.

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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.

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 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.

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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 6and 18 months of age. Repair of the cleft palate 

may require several stages of surgery as the childgrows.

b. Early correction of cleft lip enables more normal

sucking patterns and facilitates bonding. Earlycorrection of cleft palate enables development of more normal speech patterns.

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Delayed closure or large defects may require theuse 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.

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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 sutureintegrity. 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.

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