CLEFT LIP AND CLEFT PALATE
COMPARISONFEATURES CLEFT LIP CLEFT PALATE
Incidence Common among males 1/1000 Common among females 1/2500
Genetic Multifactoral Multifactoral
Description is an abnormality in which the lip does not completely form during fetal development.
occurs when the roof of the mouth does not completely close, leaving an opening that can extend into the nasal cavity.
Pathophysiology result when tissues fail to fuse
result when tissues fail to fuse
Surgical repair Cheiloplasty (logan bow) Palatoplasty
FEATURES CLEFT LIP CLEFT PALATE
Preoperative care usually occurs at 1 to 3 months of age
usually performed between 6 and 18 months of age
Position post op Supine (on his back)-to avoid injury of the operative site
Prone (on her abdomen)-to facilitate drainage of mucus and blood
Feeding post op No suckingUse Breck feeder/rubber tipped medicine dropper
No suckingUse wide-bowl spoon or paper cup.
Nursing care post op Elbow restraintLessen crying(may cause stress on suture line)Croup/mist tent (to prevent respiratory distress and to keep secretions moist)
Long term concern Bonding attachmentSocial adjustment
Defective speech, refer to speech therapistAbnormal dentition;Refer to orthodontistHearing loss; refer to audiologist
Possible Complication feeding difficultiesear infections and hearing lossspeech and language delaydental problems
feeding difficultiesear infections and hearing lossspeech and language delaydental problems
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)
c. Cleft lip can be unilateral or bilateral.d. It is due to the failure of fusion of the
maxillary and medial nasal processes (formation of the primary palate).
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.
1. Many factors are associated with the development of cleft lip and cleft palate, and cleft lip with or without cleft palate are developmentally and genetically different from isolated cleft palate.
2. Most cases appear to be consistent with the concept of multifactorial inheritance as evidenced by an increase incidence in relatives and monozygotic twins
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 these tissues fail to fuse.
Assessment findings1. Clinical manifestationsa. Cleft lip and cleft palate are readily apparent at
birth. Careful physical assessment should be performed to rule out other midline birth defects.
b. Cleft lip and cleft palate appear as incomplete or complete defects, and may be unilateral or bilateral.
2. Laboratory and diagnostic study findings. Obstetric ultrasound will reveal cleft lip while the infant is in utero.
Nursing management1. 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.
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.
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.
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 6 and 18 months of age. Repair of the cleft palate may require several stages of surgery as the child grows.
b. Early correction of cleft lip enables more normal sucking patterns and facilitates bonding. Early correction of cleft palate enables development of more normal speech patterns.
Delayed closure or large defects may require the use 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.
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 suture integrity. 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.