CLEFT LIP AND CLEFT PALATE

1.cleft lip/hare lip Notch (a hallow cut )at the lip and palate area. - it is an Congenital abnormality

TYPES OF CLEFT LIPS

According to the shape and appearance 1.Cleft lip A.Incomplete- A cleft on one side of the lip that does not extend into the nose is called unilateral incomplete.

 B.Complete- A cleft on one side of the lip that extends into the nose is called unilateral complete.

CLEFT PALATE
Cleft palate occurs when the roof of the mouth does not completely close, leaving an opening that can extend into the nasal cavity. The cleft may involve either side of the palate. It can extend from the front of the mouth (hard palate) to the throat (soft palate). Often the cleft will also include the lip. Cleft palate is not as noticeable as cleft lip because it is inside the mouth. It may be the only abnormality in the child, or it may be associated with cleft lip or other syndromes. In many cases, other family members have also had a cleft palate at birth.

CAUSES
The exact cause of cleft lip and cleft palate is not completely understood. Cleft lip and/or cleft palate are caused by multiple genes inherited from both parents, as well as environmental factors that scientists do not yet fully understand. Teratogenic-effects of drugs especially during the first trimester of pregnancy. Abnormal embryonic development during the 6-8 wks period of gestation

COMPLICATIONS OF CLEFT LIP AND CLEFT PALATE a.Digestive system feeding difficulties Regurgitation-Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not formed completely. ear infections and hearing loss Otitis media-Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Recurrent infections can then lead to hearing loss.

speech and language delay Due to the opening of the roof of the mouth and the lip, muscle function may be decreased, which can lead to a delay in speech or abnormal speech. Referral to a speech therapist should be discussed with the child's physician. dental problems As a result of the abnormalities, teeth may not erupt normally and orthodontic treatment is usually required. Oral infections due to dry mucosal lining of the mouth as the child breath through the mouth.

 Respiratory system-Aspiration pneumonia. Psychological effect Emotional stress to the parents. Low self esteem. Advice to the parents before operation 1.Feeding Breastfeeding is allowed. It will take extra time and patience. Be open for alternatives if this is not providing adequate nutrition for your infant. You may still pump your breast and feed your infant breast milk through other techniques.( EBM) Hold your infant in an upright position to help keep the food from coming out of the nose, time for feeding takes much longer and the mother should be very patient during feeding time.

 Fowlers position during feeding to prevent aspiration. Use spoon or special feeding tits Burp the child after feeding Avoid placing the child lying down soon after the child has been given feed. Place the child in lateral position whenever the child has given feed. ORAL HYGIENEProvide oral hygiene each time after feed to prevent oral infection. Provide clear water in between feeds to prevent dryness of the oral mucosa.

Attitude towards the child Treat child like any other normal child Inform the parent that this condition can be corrected by surgery. 4.Child health clinic. for assessment of growth and development especially for weighing and immunization.

Specific treatment Objective; 1.To repair the cleft 2.prevent complications 3.Enhance normal growth and development.

SURGICAL TREATMENT A.Cleft lips Repair of the cleft lip Done when the child has shown-increased body wt -increased Hb to a satisfactory level. Usually done when the child is 3-6 months although can be done at any age.

Purpose; development of complete facial structure. After operation the suture is supported with a butterfly dressing or tape and restraining of the childs hand done to prevent the child from touching the incision.

SURGICAL TREATMENT
B.Palatoplasty -Repair of the cleft palate. -Done before the child starts to speak. -Usually at age 1-2 years old. -usually when the baby is 10 to 12 pounds -The time necessary to allow for complete formation of the palate.

PRE OPERATIVE PREPARATION A.Mental/physical preparation 1.Information to parent regarding; a.purpose of operation -to repair the cleft to prevent complications -Helps with growth and development of the child. b.Pre-op preparations Exampleoral hygiene will be refered to the anaesthetist. Investigations done to ensure the safe operations. c.further information is provided to parents. d.will be done under GA.

 E.provide information regarding outcomes of operation Example-will have suture line after repaire -Butterfly dressing will be placed to prevent stress at the suture line. -pain will be relieved with administration of analgesics. -child can take orally after fully recovered from anasthesia.

 F.Others Introduce to other parents who have had the child with the same problem. B.Physical preoperative preperation Morning-- the day before the operation 1.Investgation-BUSE,Hb -nasal and throat swab. 2.Consent 3.Refer anesthetist 4.Nutrition -enough nutrition to ensure child fit to undergo operation -correct technique by placing baby in fowlers position. -Use special equipment for feeding like cup feedings. 5.Getting child adapting to condition after the operation lateral position elbow restrain.

 Night before the operation 6.NPO 7.IVD as ordered MORNING OF THE OPERATION 8.Change to OT attire 9.Vital signs 10.Pre medications as ordered 11.Ensure childs safety

 POSTOPERATIVE CARE 1.Maintain airway lateral position avoid oral and nasal suction to prevent injury to the suture line and the wound. 2.observations -vital signs-Bp,pulse.respiration,skin colour,temp. -level of conciousness -bleeding from sutureline

 3,Diet and fluid -NPO until fully recovery from anesthesia. -allow oral feed only fully conscious -use special feeding equipment. special feeding tits which is appropriate and soft. -fowlers position during feeding -burb after feeding -oral hygiene after feeding.

 4.care of wound i.Prevent infection -swab wound with moist swab gently using aseptic technique. -clean suture after each feeding. -apply medication as per order like chloramphenicol, bacitracin. ii.Prevent stress to the suture line. Butterfly dressing to prevent stress over the sutures. -Elbow restrain -lateral position. -avoid child from crying -administer analgesic as per order.

 Iii.wound circulation -avoid tight sutures S.T.O 10th P.O day if silk is used. iv.Usually gatgut is used,so no need to remove.