Cleft Lip and Palate

Prepared by:
John Paul Hocon
Disease Description
 Cleft lip (cheiloschisis) is a congenital anomaly
that occurs at a rate of 1 in 800 births.
 If the cleft does not affect the palate structure of the
mouth it is referred to as cleft lip.
 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)
 Cleft lip can be unilateral or bilateral.
 It is due to the failure of fusion of the maxillary and
medial nasal processes (formation of the primary
palate).
 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.
 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.
 It ranges in severity from soft palate involvement
alone to a defect including the hard palate and
portions of the maxilla.
 Cleft palate may or may not be associated with cleft
lip.
 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.
Etiology
 Many factors are associated with the
development of cleft lip and cleft palate, and
cleft lip with or without cleft palate is
developmentally and genetically different from
isolated cleft palate.
 Most cases appear to be consistent with the
concept of multifactorial inheritance as evidenced
by an increase incidence in relatives and
monozygotic twins.
Pathphysiology
 During embryonic development the lateral and
medial tissues forming the upper lip palates fuse
between weeks 7 and 8 of gestation; the palatal
tissues forming the hard and soft palates fuse
between weeks 7 and 12 gestation.
 Cleft lip and cleft palate result when these
tissues fail to fuse.
Assessment findings
 Clinical manifestations
 Cleft lip and cleft palate are readily apparent at birth.
Careful physical assessment should be performed to
rule out other midline birth defects.
 Cleft lip and cleft palate appear as incomplete or
complete defects, and may be unilateral or bilateral.
 Laboratory and diagnostic study findings.
Obstetric ultrasound will reveal cleft lip while the
infant is in utero.
Nursing Management
 Assess for problems with feeding, breathing parental
bonding, and speech.
 Ensure adequate nutrition and prevent aspiration.
 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.
 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.
 Feed the infant slowly and burp frequently to prevent
excessive swallowing of air and regurgitation.
 Stimulate sucking by gently rubbing the nipple against the
lower lip.
 Support the infant’s and parents’ emotional
and social adjustment.
 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.
 Emphasize the infant’s positive aspects and express
optimism regarding surgical correction.
Pre-operative care
 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.
 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.
 Delayed closure or large defects may require the use of
orthodontic appliances.
 The responsibilities of the nurse are to:
 Reinforce the physician’s explanation of surgical procedures.
 Provide mouth care to prevent infection.
Post-operative Care
 Assess airway patency and vital signs; observe for edema
and respiratory distress.
 Use a mist tent, if prescribed, to minimize edema, liquefy
secretions, and minimize distress.
 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.
 Clean the suture line and apply an antibacterial ointment as
prescribed to prevent infection and scarring. Monitor the site
for signs of infection.
 Use elbow restraints to maintain suture line integrity.
Remove them every 2 hours for skin care and range-
of-motion exercises.
 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.
 Attempt to keep the child from putting tongue up to
palate sutures.
 Manage pain by administering analgesic as
prescribed.
Nursing Care Plan
 ASSESSMENT

SUBJECTIVE:
“I noticed that my son cannot suck my nipples
properly during breastfeeding”

OBJECTIVE:
 Difficult in feeding

 Malformation of lips and roof of the mouth

Diagnosis
Risk for Aspiration(Breast Milk, formula or
mucus) as related to anatomic effect.
Planning
After 30 minutes of nursing intervention,
position the infant in a proper position like
football hold to maintain proper breathing
pattern to prevent from aspiration or choking.
Expected Outcome
 Airway Maintenance:
Toleration of enteral feedings without
aspiration.
 The infant exhibits no signs of respiratory
distress
Intervention
Aspiration Precautions:
 Prevention or minimization of risk factors in
the patient at risk of aspiration.
 if theres a case an infant has an episode of
choking or aspiration position the infant in a
football hold to maintain proper breathing.
Rationale
 to
prevent from possible of episode of
choking or aspiration
Evaluation
After 30 minutes of nursing intervention the
infant can breath properly after he/she was
positioned in a football hold to maintain
proper breathing pattern