CLEFT LIP CLEFT PALATE

PRESENTED BY: IVAN AVENADO

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.

TYPES OF CLEFT LIP & CLEFT PALATE

Cleft lip without a cleft palate Cleft palate without a cleft lip Cleft lip and cleft palate together Partial or incomplete cleft Complete cleft Unilateral complete cleft Bilateral complete cleft

CAUSES
Genetic factor Maternal factors Environmental factors Teratogenic drugs Family history

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

DIAGNOSTIC PROCEDURE
Ultrasound to diagnose cleft lip and cleft palate before birth An ultrasound is a test that uses sound waves to create pictures of the developing fetus. When analyzing the pictures, a doctor may detect an abnormality in the facial structures. Cleft lip may be detected with ultrasound beginning around the 18th week of pregnancy. As the fetus continues developing, it may be easier to accurately diagnose a cleft lip. Cleft palate that occurs on its own is more difficult to diagnose using ultrasound, since it can be difficult to see inside the fetus' mouth. If fetal ultrasound shows a cleft, your doctor may offer a procedure to take a sample of amniotic fluid from your uterus (amniocentesis). Analyzing the fluid may reveal abnormalities that indicate the fetus has inherited a genetic syndrome that can cause other birth defects. However, most often cleft lip and cleft palate occur on their own.

PATHOPHYSILOGY
The embryological development of the upper lip and nose 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 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.

MEDICAL MANAGEMENT
The goals of treatment for cleft lip and cleft palate are to ensure the child's ability to eat, speak, hear and breathe and to achieve a normal facial appearance. Treatment involves surgery to repair the defect and therapies to improve any related conditions. Rule of 10s" coined by surgeons Wilhelmmesen and Musgrave in 1969
the child is at least 10 weeks of age; weighs at least 10 pounds, and has at least 10g hemoglobin).

SURGICAL MANAGEMENT
Surgery to correct cleft lip and palate is based on your child's particular

situation. Following the initial cleft repair, your doctor may recommend followup surgeries to improve speech or improve the appearance of the lip and nose. Surgeries typically are performed in this order: Cleft lip repair between 1 and 4 months of age Cleft palate repair between 5 and 15 months of age Follow-up surgeries between age 2 and late teen years Cleft lip repair. To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together. The repair should create a more normal lip appearance, structure and function. Cleft palate repair. Various procedures may be used to close the separation and rebuild the hard and soft palate (roof of the mouth), depending on your child's particular situation. The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed. Ear tube surgery. For children with cleft palate, ear tubes also may be placed during the first surgery to reduce the risk of frequent ear infections, which can lead to hearing loss. Ear tube surgery involves placing tiny cylinders in the eardrum to prevent fluid buildup. Surgery to improve cosmetic appearance. Additional surgeries may be needed to improve the appearance of the mouth, lip and nose

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

Nursing Management
Aspiration Precautions: Prevention or minimization of risk factors in the patient at risk of aspiration.
Position upright for feedings.

Family Involvement: Facilitating family participation in the emotional and physical care of the child.
Assess parents knowledge of the defect, their degree of anxiety and level of discomfort, and the interpersonal relationships among family members

Nutrition Management: Provision of a balanced dietary intake of foods and fluids.

Provide 100150 cal/kg/day and 100130 mL/kg/day of feedings and fluid. If the infant needs an increased number of calories to grow, referral to a nutritionist should be made. Formulas with higher calorie concentrations per ounce are available without increasing total fluids.