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Cleft Lip

Cleft lip and palate is a birth defect where the lip and roof of the mouth do not fully fuse during development, ranging from a small notch in the upper lip to a complete separation, and can affect feeding, speech, and dental development; it is usually treated with surgery to repair the cleft and long-term follow up including speech therapy and dental care is important to manage complications. Cleft lip and palate has genetic and environmental causes including folic acid deficiency and occurs in about 1 in 700 live births.

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151 views

Cleft Lip

Cleft lip and palate is a birth defect where the lip and roof of the mouth do not fully fuse during development, ranging from a small notch in the upper lip to a complete separation, and can affect feeding, speech, and dental development; it is usually treated with surgery to repair the cleft and long-term follow up including speech therapy and dental care is important to manage complications. Cleft lip and palate has genetic and environmental causes including folic acid deficiency and occurs in about 1 in 700 live births.

Uploaded by

Grazie
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CLEFT LIP PALATE

Definition:

The fusion fails to occur in varying degrees, causing this disorder to range from a small
notch in the upper lip to total separation of the lip and facial structure up into the floor of the
nose, with even the upper teeth and gingival absent. It is more prevalent among boys than girls. It
occurs at a rate of approximately 1 in every 700 live births (Kirscher, Carman-Dillon, & Low,
2003). In cleft palate, the fissure may affect only the uvula and soft palate or may extend forward
to the nostril and involve the hard palate and the maxillary alveolar ridge.

Types:

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). Lip cleft can occur as a
one sided (unilateral) or two sided (bilateral). It is due to the failure of fusion of the maxillary
and medial nasal processes (formation of the primary palate).

Unilateral incomplete Unilateral complete Bilateral complete

A mild form of a cleft lip is a microform cleft. A microform cleft can appear as small as
a little dent in the red part of the lip or look like a scar from the lip up to the nostril. In some
cases muscle tissue in the lip underneath the scar is
affected and might require reconstructive surgery. It
is advised to have newborn infants with a microform
cleft checked with a craniofacial team as soon as
possible to determine the severity of the cleft.

Causes:

Cleft lip occurs as a familial tendency or


most likely occurs from the transmission of multiple
genes. It is twice as prevalent in the Japanese
population and occurs rarely in African American.
Formation may be aided by teratogenic factors
present during weeks 5 to 8 of intrauterine life, such
as a viral infection or possibly a deficiency of folic
acid.
Pathophysiology:

Predisposing Factors: Precipitating Factors:


Infants Viral infection
Both genders than Folic acid deficiency
higher in male
Etiology: incomplete fusion
of the nasomedial or
intermaxillary process
during the 2nd month of
embryonic development

The cleft causes structures of


the face and mouth to develop
without the normal restraints of
encircling lip muscles

It may affect not only lip but also

External nose Nasal septum Alveolar processes Nasal cartilages

Bilaterally

Usually just beneath


the center of one nostril Symmetric

Asymmetric

The more complete the


cleft lip, the greater the
chance that teeth in the
line of the cleft will be
missing or malformed
Signs and Symptoms:

Feeding the infant with cleft lip usually presents no difficulty if the cleft lip is simple and
the palate intact. A baby with cleft palate usually requires large, soft nipples with crosscut
openings. Breastfeeding may be impossible for some infants. An orthodontic prosthesis for the
roof of the mouth may facilitate sucking for some infants.

Complications:

The complications of cleft lip and cleft palate can vary greatly depending on the degree and
location of the cleft. They can include all or some or all of the following:

 Breathing: When the palate and jaw are malformed, breathing becomes difficult.
Treatments include surgery and oral appliances.

 Feeding: Problems with feeding are more common in cleft children. A nutritionist and
speech therapist that specializes in swallowing may be helpful. Special feeding devices
are also available.

 Ear infections and hearing loss: Any malformation of the upper airway can affect the
function of the Eustachian tube and increase the possibility of persistent fluid in the
middle ear, which is a primary cause of repeat ear infections. Hearing loss can be a
consequence of repeat ear infections and persistent middle ear fluid. Tubes can be
inserted in the ear by an otolaryngologist to alleviate fluid build-up and restore hearing.

 Speech and language delays: Normal development of the lips and palate are essential
for a child to properly form sounds and speak clearly. Cleft surgery repairs these
structures; speech therapy helps with language development.

 Dental problems: Sometimes a cleft involves the gums and jaw, affecting the proper
growth of teeth and alignment of the jaw. A pediatric dentist or orthodontist can assist
with this problem.

Management:

1. 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 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.
3. 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.

4. 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:
 Reinforce the physician’s explanation of surgical procedures.
 Provide mouth care to prevent infection.

5. 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.

6. 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.

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