CLEFT LIP

AND PALATE
 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)
a. c. Cleft lip can be unilateral or bilateral.
b. d. It is due to the failure of fusion of the maxillary and
medial nasal processes (formation of the primary palate).
2. 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.

3. Children with these structural disorders may have

associated dental malformations, speech problems,
and frequent otitis media, the latter resulting from
improper functioning of the Eustachian tubes.
Cleft Lip & Palate
Clinical Manifestations
 Physical appearance of cleft lip or
palate:
o Incompletely formed lip varies from slight notch
in vermilion to complete separation of lip.
o Opening in roof of mouth felt with examiner's
finger on palate.

 Eating difficulty:
o Suction cannot be created for effective sucking.
o Food returns through the nose.
o Nasal speech.
 Diagnostic Evaluation

Prenatal ultrasonography enables many cleft lips

and some cleft palates to be identified in utero.
Magnetic resonance imaging (MRI) to evaluate
extent of abnormality before treatment.
Photography to document the abnormality.
Serial X-rays before and after treatment.
Dental impressions for expansion prosthesis.
Genetic evaluation to determine recurrence risk.
Treatment
Surgery
Cleft Lip – often preferred age is at
approximately 10 weeks of age; weighs at least 10
pounds, and has at least 10g hemoglobin.
Cleft Palate – usually performed between 6 and
12 months. Approximately 20-25% only require
one palatal surgery to achieve a competent
velopharyngeal valve capable of producing
normal, non-hypernasal speech.
Speech and Hearing Treatment
Cleft lip repair. The edges of the cleft between the lip and nose are cut (A and B). The bottom of the nostril is formed with
suture (C). The upper part of the lip tissue is closed (D), and the stitches are extended down to close the opening entirely (E).
Some before & after photos
 Nursing Responsibilities
Nursing Assessment
If the patient has a cleft lip, assess for cleft palate
by direct visualization and palpation with finger.
Obtain family history of cleft lip or palate.
Evaluate feeding abilities.
Effectiveness of suck and swallow
Amount taken
Observe for other syndromic features.
Nursing Interventions

1. 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 semiupright 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.
2. 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.
3. 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.
c. 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.
 4. 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.
c. 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.
5. Provide child and family teaching.

Demonstrate surgical wound care.

Show proper feeding techniques and positions.
Explain that temperature of feeding formulas should be monitored
closely because new palate has no nerve endings; therefore; the child
can suffer a burn to the palate easily and without knowing it.
Explain handling of prosthesis if indicated.
Stress the importance of long-term follow up, including speech therapy,
and preventing or correcting dental abnormalities.
Discuss the need for, at least, annual hearing evaluations because of
the increased susceptibility to recurrent otitis. The child may require
myringotomy and surgical placement of drainage tubes.
Teach infection control measures.
 Presented by:
Lirio Gay Tubil
Ivy Kris H. Zorrilla
Make The World a Happier Place – SMILE!