Cleft Lip Palate[1]

7/28/2019 Cleft Lip Palate[1]

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Cleft lip (cheiloschisis) and cleft palate(palatoschisis) (colloquially known asharelip), which can also occur together ascleft lip and palate, are variations of a typeof clefting congenital deformity caused byabnormal facial development during

gestation

A cleft is a fissure or openinga gap. It isthe non-fusion of the body's naturalstructures that form before birth


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Development of the face and palate http://www.indiana.edu/~anat550/hnanim/f

ace/face.html
http://www.indiana.edu/~anat550/hnanim/face/face.htmlhttp://www.indiana.edu/~anat550/hnanim/face/face.htmlhttp://www.indiana.edu/~anat550/hnanim/face/face.htmlhttp://www.indiana.edu/~anat550/hnanim/face/face.html


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The palate structure of the mouth is notaffected

The clef is on top of the lip as either asmall gap or an indentation in the lip(partial or incomplete cleft) or it continuesinto the nose (complete cleft)

Lip cleft can occur as a one sided

(unilateral) or two sided (bilateral)


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Unilateral Incomplete Unilateral Complete Bilateral Complete


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A mild form of a cleft lip is amicroform cleft. It can appear as a little dent in the redpart of the lip or look like a scar fromthe lip up to the nostril

In some cases muscle tissue in the lipunderneath the scar is affected and

might require reconstructive surgery


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The two plates of the skull that form thehard palate (roof of the mouth) are notcompletely joined

The soft palate is in these cases cleft as

well. In most cases, cleft lip is also present

Can occur as complete (soft and hard

palate, possibly including a gap in thejaw) or incomplete (a 'hole' in the roof ofthe mouth, usually as a cleft soft palate


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When cleft palate occurs, the uvula isusually split.

The hole in the roof of the mouthcaused by a cleft connects the mouthdirectly to the nasal cavity
http://en.wikipedia.org/wiki/Palatine_uvulahttp://en.wikipedia.org/wiki/Nasal_cavityhttp://en.wikipedia.org/wiki/Nasal_cavityhttp://en.wikipedia.org/wiki/Palatine_uvula


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Incomplete cleft

palate

Unilateral complete

lip and palateBilateral complete lip

and palate


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A direct result of an open connectionbetween the oral cavity and nasal cavity

is velopharyngeal insufficiency (VPI). Because of the gap, air leaks into thenasal cavity resulting in a hypernasal

voice resonance and nasal emissions Secondary effects of VPI include speecharticulation errors (e.g., distortions,

substitutions, and omissions)


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Unknown

Medications

Smoking

Parental age Family history

Race

Gender


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Ear infections/ hearing loss.Children with cleft palate are at increased risk of

ear infections since they are more prone to fluidbuild-up in the middle ear.

If left untreated, ear infections can cause hearingloss.

To prevent this from happening, children with cleftpalate usually need special tubes placed in the

eardrums to aid fluid drainage, and their hearing

needs to be checked once a year


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Speech problemsChildren with cleft lip or cleft palate may also

have trouble speaking. These children's voicesdon't carry well, the voice may take on a nasal

sound, and the speech may be difficult to

understand. Not all children have these

problems and surgery may fix these problems

entirely for some


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Dental Problems Children with clefts are more prone to a larger than

average number of cavities and often have missing,extra, malformed, or displaced teeth requiringdental and orthodontic treatments.

In addition, they often have an alveolar ridge

defect. A defect in the alveolus can (1) displace,tip, or rotate permanent teeth, (2) preventpermanent teeth from appearing, and (3) preventthe alveolar ridge from forming. These problems

can usually be repaired through oral surgery.


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Breastfeeding is allowed. It will take extratime and patience

The infant is held in an upright position tohelp keep the food from coming out of thenose

Small, frequent feedings are recommended

In some cases, supplements may be added to

breast milk or formula to help infant meethis/her calorie needs


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NUK nipple; The hole can be made larger by making acriss-cross cut in the middle.Mead Johnson Nurser;This is a soft, plastic bottle thatis easy to squeeze and has a large crosscut nipple.You may use any nipple that the infant prefers withthis system.

Haberman Feeder;This is a specially designed bottlesystem with a valve to help control the air the babydrinks and to prevent milk from going back into thebottle.

Syringes;These may be used in hospitals following cleftsurgery and may also be used at home. Typically, asoft, rubber tube is attached on the end of thesyringe, which is then placed in the infant's mouth.


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Feeding baby with clef palate http://www.cleftline.org/parents/feeding_you

r_baby
http://www.cleftline.org/parents/feeding_your_babyhttp://www.cleftline.org/parents/feeding_your_babyhttp://www.cleftline.org/parents/feeding_your_babyhttp://www.cleftline.org/parents/feeding_your_baby


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Multidisciplinary approach

plastic/craniofacial surgeon -. Pediatrician

Orthodontist

Speech and language specialist

Otolaryngologist

audiologist

genetic counselor

nursing team social worker


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Infants with cleft lip alone, can be

repaired within the first severalmonths of life (usually when the babyis 10 to 12 pounds).

Repair of a cleft palate often requiresmultiple surgeries


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Additional surgeries may be performed toimprove the appearance of the lip and nose,

close openings between the mouth and nose,help breathing, and stabilize and realign the

jaw.

Final repairs of the scars left by the initialsurgery will probably not be performed untiladolescence, when the facial structure ismore fully developed.


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child may be irritable following surgery

child may also have to wear padded restraintson his/her elbows to prevent him/her fromrubbing at the stitches and surgery site.

Stitches will either dissolve on their own orwill be removed in approximately five toseven day

In some cases, packing will be placed on the

palate


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For a day or two, child will feel mild pain

It is normal to have swelling, bruising, and bloodaround these stitches

There may be some bloody drainage coming fromthe nose and mouth that will lessen over the firstday.

child will have an intravenous catheter (IV) toprovide fluids until he/she is able to drink bymouth

Many infants show signs of nasal congestion after

surgery. These signs may include nasal snorting,mouth breathing, and decreased appetite.


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child will be on antibiotics

small amount of water should be offered after

every bottle or meal to cleanse the incision.

Continual to rinsing of this area gently with

water several times a day, if necessary.

child can walk or play calmly after surgery.He/she should not run or engage in rough p


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Altered comfort pain

Altered nutrition Risk for compromised family coping related

to stress of surgery

Risk for injuries or difficulities with airwaymanagement

Risk for infection

Cleft Lip Palate[1]

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