for msc nursing

1. CLEFT LIP AND CLEFT PALATE
PRESENTED BY :
K.R. LOYAL
GCON JAIPUR.

3. DEFINITION
 CLEFT LIP: It is gap or indentation
in the lip or split continued up to
nostril due to failure of fusion of the
maxillary and medial nasal process.

4. Cont…...
 CLEFT PALATE: It is the condition
in which the two plates of skull that
forms hard are not completely
joined due to the failure of fusion of
palatine processes , nasal septum
and medial palatine process .

5. EMBRYOLOGY
 Primary palate forms - 4th to 7th wk.
 Secondary palate forms – 6th to 9th wk.
 Cleft lip occurs when an epithelial
bridge fails.
 Cleft of primary palate occur anterior
to incisive foramen.
 Cleft of secondary palate occurs
posterior to incisive foramen.

6. Etiology
 Genetic –
inheritance , chromosomal aberrations .
 Environmental teratogens-
IU Exposure to anticonvulsant phenytoin
,alcohol ,retinoic acid ,smoking, viral
infection.
 Maternal – DM , advanced paternal and
maternal age ,
 Unknown etiology.

7. Classification
 According to prof. Balakrishan its can
be divided into three group.
Group I : only cleft lip(may be
unilateral, bilateral or midline.)
Group II : only cleft palate (may be
unilateral, bilateral or sub mucosal.)
Group III :both cleft lip , alveolus and
cleft palate(may be unilateral, bilateral
or midline.)

9. Clinical feature
 Cleft lip : Notched vermilion border and
may involve alveolar ridge .
 Cleft palate: nasal distortion ,exposed
nasal cavities .
 Misaligned teeth
 Passage of milk through nasal passage
during feeding.
 Recurrent ear infection.
 Speech difficulties.
 FTT AND Poor weight gain .

10. Diagnosis
 Newborn examination at birth.
 Palpate palate with gloved fingure or
visual examination with flash light.
 In utro USG(TVS preferred)

11. Problems / complication
Immediate
 Feeding difficulties
 Breathing problem
Long term-
 Recurrent ear infection and hearing
loss.
 Speech difficulties
 Malocclusion of teeth
 Maxillary cleft.

13. Cont…..
Modified feeding
 30-45 degree angle feeding
 Hold baby upright and frequent feeding
 Haberman feeder and NUK NIPPLE used
for feeding
 Following techniques used for feeding
ESSR . E=enlarded nipple, s= stimulate
suckingreflex ,S= swallow fluid
appropriately, R= rest when infant signals.

14. Non surgical managment
 Dental obturator for high risk patient
 Or who refuse surgeories
 Lanthum appliances to expand and
realign the parts of the palate.

15. Surgical managment
Cheiloplasty (cleft lip repair)
 2wk – lip adhesion is done to convert
complete cleft lip into incomplete .
 10 wk- cleft lip repaired follow rule of
10(10 wk,10mg/dl Hb and 10 lb
weight)
 Procedures used are –Millard
repair,Rose thompson or Randall
Grahm procedure.

16. Cont…
Palatoplasty (cleft palate repair):-
 Repaired at 9 to 12 month age.
 Procedure used for repair are:-
V-Y push back ,two flap palatoplasty,
schweckendick’s primary veloplasty,
and Furlow palatoplasty.

17. Cont….
Speech and hearing treatment:
 A tympanostomy tube inserted into
eardrum to aerate the middle ear to
improve hearing.
 speech problems are treated by
speech language pathologist. (in some
cases pharyngeal flap surgery
performed.

18. Nursing managment
Preoperative care
 Nursing diagnosis are-
Imbalanced nutrition less than body
requirement R/t inability to suck due to
cleft lip and palate.
Risk of aspiration R/t increased air
drinking during feeding
Knowledge deficiet of parents R/t care
of child before surgeries.

19. Cont….
Postoperative care
 Nursing diagnosis:-
Imbalanced nutrition less than body
requirement R/t repair.
Risk of trauma R/t newborn desire to
touch the operated site.
Risk of aspiration
Pain R/t surgical procedure.
Risk of infection.