Cleft Lips And Cleft Palate
- Cleft lips and Cleft palate is congenital anomalies that occur as a result of the failure of soft tissue or bony structure to fuse during the embryonic periods.
- Cleft lips and palate may be complete and partially.
- Cleft lips are also known as “hare lip“
Cleft Lips(hare lip)
- Also known as CHEILOSCISIS
- Cleft lips occur when the maxillary process is failed to fuse with the medial nasal process
- It may be unilateral or bilateral
- It occurs during 5-12 weeks of gestational age
- Incidence is 1 in 800 live births
- Also known as Palatoschisis
- Cleft palate occurs when the lateral palatine process is failed to fuse
- The severity of cleft palate is involve Uvula to the nasopalatine foramen
- It occurs during 12-14 weeks of gestational age
- Incidence 1 in 2000 live birth
Etiology of cleft lip and palate
- Maternal smoking and exposure to passive smoke
- Drugs – Accutane, Phenytoin, Warfarin, ethanol etc.
- Maternal folic acid deficiency
- Hereditary and environmental factors
- Exposure to radiation and rubella virus.
- Chromosomal abnormalities
- Teratogenic factors
- Prolonged Maternal Anemia
Clinical features of cleft lip and palate
- Failure to weight gain
- Feeding problem
- Poor Growth
- Repeated ear infection and speech difficulty
- Dental abnormalities
- Middle ear fluid buildup and hearing loss
- Psychological problem
Management Cleft Lips And Cleft Palate
Medical Cleft Lips And Cleft Palate hare lip
- Firstly nurse assesses the physical Examination for cleft lips and gloved fingers use for cleft plate
- Assess the ability to suck, swallow, and breathe
- Slow and small quantity feeding is provided
- Palade spoon, Medicine dropper, and syringe with catheter etc, use for feeding.
- Intermittent burping during the feeding
- Provide rest
- Baby, semi upright position provide during feeding and side lateral position after feeding.
- Bulb syringe or suction apparatus keep near to bed side.
2. Surgical Cleft Lips And Cleft Palate hare lip
- Cheiloplasty – For Cleft lips
- Palatoplasty- For Cleft plate
- It is a plastic surgical procedure for repair the cleft lips
- The procedure is done at 3-6 months
- There is minimally invasive surgical procedure
- Z shape suturing use in cheiloplasty to minimize the changes of separation of a suture.
- Use 10 “rainbow” (C-shape) after the surgery to minimize the pressure on suture.
- The prone position should be avoided in cheiloplasty-treated children. Only lateral and semi-upright positions provide
- After feeding, the suture line is cleaned with NS sterile water, etc.
- Palatoplasty is a surgical procedure for the correct the palate with cleft palate person.
- Palatoplasty procedure done at 6-18 months of age.
- Palatoplasty procedure fill the gap of palate by MUCO PERIOSTEUM FLAP
- Oral packing should be done after the surgery.
- Prone position recommended for palatoplasty patient.
- Recurrent Otitis media (Hearing loss) – due to dysfunction of Eustachian tube.
- Feeding problem
- Speech Problem
- Recurrent Respiratory tract infection
- Nursing Management
- Nurse should carefully perform the head to toe assessment and assess the cleft lips and cleft palate deformity.
- Nurses assess the client lips by visually and cleft palate by gloved figures.
- Nurse assess the feeding pattern of the child
- Assess the need for the surgical correction
- Airway clear and provide proper position
- Nurse encourage the parents to accept the child condition
- Provide the complete immunization before the surgery
- Elbow and jacket restrain provide after the surgery
- Avoid the use of oral suctioning, Tounge depressor, oral temp., thermometer etc.
- Don’t allow the child to brush and do not allow hard food to baby
- Avoid the contact of the sharp object to the suture line.
- KEY POINTS
- The maxillary process is failed to fuse with the medial Nasal process is known – Cleft lips
- Cleft palate Occur during the – 12-14 weeks of gestational age
- Priority Nursing management in cleft lips and cleft palate – Clearance of airway
- Which type of restrain use in the cleft plate and the cleft lips – Elbow and jacket Restrain
- Which position is provided during the Feeding baby with Cleft lips and cleft Palate – Semi-upright Position