CLEFT LIP & CLEFT

PALATE

INTRODUCTION
Cleft is a fissure or opening a gap
It is the non-fusion of the bodys 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

PATHOPHYSIOLO
The embryological development
of the upper lip and nose
GY
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

PATHOPHYSIOLO
GY
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 postoperative 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 childs 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