cleft lip

1. Cleft Lip And Palate
Management
Ismael, Colmenares
Joseph de Veyra
Al Goytia

2. Statistics
 CL +Palate 1 in 1000 live births (Aus)
 1 in 500 (Asians) 1 in 2000(African)
 CP 1 in 2000 all races
 CL+P:CL:CP =2:1:1
 Left:Right:Bilateral is 6:3:1

3. What went wrong?

5. Cleft Lip
 Oral clefting occurs when the tissues of the lip and/or
palate of a fetus don't grow together
 Children with clefts often don't have enough tissue in
their mouths,
 tissue they do have isn't fused together properly to form
the roof of their mouths.
 A cleft lip appears as a narrow opening or gap in the
skin of the upper lip that extends all the way to the base
of the nose. A cleft palate is an opening between the
roof of the mouth and the nasal cavity.
 Some kids have clefts that extend through both the front
and rear part of the
 palates, while others have only partial clefting.

6. The three common kinds of clefts
1. cleft lip without a cleft palate
2. cleft palate without a cleft lip
3. cleft lip and cleft palate together

7. Why it went wrong!
 Unknown
 Medications
 Smoking
 Parental Age
 Family History
 Racial
 Gender
 Syndromic(17.5%CP have Sticklers)

8. Antenatal Diagnosis

10. Surgery for Oral Clefting
 Surgery is usually performed during the first 3 to 6
months to repair cleft lip and between 9 and 14 months
to repair the cleft palate.
 Both types of surgery are performed in the hospital
under general anesthesia.
 Cleft lip often requires only one reconstructive surgery,
especially if the cleft is unilateral.
 The surgeon will make an incision on each side of the
cleft from the lip to the nostril. The two sides
 of the lip are then sutured together. Bilateral cleft lips
may be repaired in two surgeries, about a month apart,
which usually requires a short hospital stay.

11.  Cleft palate surgery involves drawing tissue
from either side of the mouth to rebuild the
palate.
 It requires 2 or 3 nights in the hospital,
with the first night spent in the ICU.
 The initial surgery is intended to create a
functional palate, reduce the chances that
fluid will develop in the middle ears, and
help the teeth and facial bones develop
properly.
 In addition, this functional palate will help
speech development and feeding abilities.
 Some kids require more surgeries to help
improve their speech.

12.  Later surgeries are usually scheduled at
least 6 months apart to allow time to heal
and to reduce the chances of serious
scarring.
 It's wise to meet regularly with the plastic
surgeon to determine what's most
appropriate in your child's case.
 Final repairs of the scars left by the initial
surgery may not be performed until
adolescence, when facial structure is more
fully developed.
 Surgery is designed to aid in normalizing
function and cosmetic appearance so that
kids will have as few difficulties as
possible.

13. Fetal Lip Repair

14. Birth

15. Lip Repair

25. Bilateral Lip Repair

28. Lip:post operative management
 Arm splints for 10 days
 Breast feed best
 Syringe feed,cup and spoon
 Avoid hard teats
 Home at 24-48 hours
 If required, sutures out at 1 week
 Massage scar tds, warn about contraction

29. Palate repair

35. Palate:post operative care
 Risks are airway and bleeding
 Arm splints
 Clear fluids overnight
 Syringe, sipper cup,spoon soft diet as
tolerated
 Home at 48-72 hrs
 Secondary bleed at 7-8 days

36. Hearing

37. Cleft Palate
 97% have otitis media
 Eustachian tube dysfunction- mechanism
unknown ?mechanical
 Best time for grommet insertion is 3
months (at time of Cleft lip repair or 6
months if palate repaired only)

40. Touch Ups

41. New surgical technique promises
hope for Cleft Palate Patients
 A Mayo Clinic laboratory study in animals suggest that
using distraction osteogenesis, a procedure that uses
the mechanical force of an appliance to lengthen soft
tissue and bone, may be a feasible and effective method
to repair cleft palate in the future
 The distraction osteogenesis method is designed to
gradually lengthen the bone of the palate through
tension.
 An appliance made of a central body piece, four plates
and screws is
surgically inserted with the patient under anesthesia.

42.  After a rest period of 10 days, a key in the
appliance is turned slightly each day for
four weeks to slowly lengthen the bone
and soft tissue. Finally, the device is
surgically removed.
 Currently, standard treatment for cleft
palate repair involves surgery in which the
mucosal flaps of the roof of the mouth
are sewn together over the cleft.
 The actual missing bone is not repaired.

43. Problems associated with the current
Cleft Palate surgery method
 Leaves exposed areas of hard palate bone,
producing scars that sometimes interfere with
the child's later midfacial growth.
 Poor cosmetic appearance is usually the result of
midfacial growth and can result in poor contact
between lower and upper teeth when the child's
mouth is closed.
 An increased risk of the wound splitting open or
the creation of an abnormal passage between
the
mouth and nose is a possibility.
 The current repair method also may shorten and
scar the soft palate, which can impair speech.

44. Laboratory Trials
 The study of this method of cleft palate repair
was conducted on 10 adult hounds, due to
similarities to the human mouth.
 Two hounds served as study controls and had a
surgically created cleft palate, but no
subsequent repair.
 In the other eight hounds, the distraction
osteogenesis device was used to close the cleft
palate.

45. Laboratory Results
 In 7 of the 8 hounds that were treated, researchers
observed some degree of bony closure of the cleft; in 5
of them the cleft was closed completely with no side
effects.
 The researchers are currently working on perfecting the
technique through study of the hounds with incomplete
closure.
 The researchers also felt that the distraction
osteogenesis device used in this study was too bulky, so
they are now testing another more agile apparatus, says
Dr. Moore. (Eric Moore, M.D., Mayo Clinic
otorhinolaryngologist and one of the study's
investigators.)

46. Help International
 Help International travels with a team coming
from Cedars Sinai
 The trip is 10 days in total including 5 days of
surgery.
 Each day the team performs about 130 surgeries
and work around 13 hrs.
 Their days starts around 6 am and ends at 10pm
by the time they get to camp.
 They provide their own supplies from or tables
to instruments to portabe anesthesia.

47.  The whole team includes around 110 people from
surgeons to cooks. T
 The program is completely voluntary and each
person spends around $1700 out of their own
pocket to go.
 According to one of them, it is really rewarding to
the staff to know they help people that otherwise
would not have the opportunity to have this kind of
surgery.

48. Speech

49. Speech
 80% of CP patients have normal speech
after repair
 15% achieve acceptable speech after
therapy

50. Speech Therapy
 Kids with oral clefting may have trouble
speaking — the clefting can make the voice
nasal and difficult to understand. Some will find
that surgery fixes the problem completely.
 Catching speech problems early can be a key
part of solving them. A child with a cleft should
see a speech therapist between the ages of 18
months and 2 years.
 Many speech therapistslike to talk with parents
at least once during the child's first 6 months to
provide an overview

51.  After the initial surgery is completed, the
speech pathologist will see the child for a
complete assessment.
 The therapist will evaluate developing
communication skills by assessing the
number of sounds the child makes and the
actual words he or she tries to use, and by
observing interaction and play behavior.
 This analysis helps determine what, if any,
speech exercises a child needs and if further
surgery is needed. The speech pathologist
often will continue to work with the child
through additional surgeries.
 Many kids will work with a speech therapist
throughout their grade-school years.

52. Summary
 Birth
 3 months-------------LIP
 6-9 months-----------PALATE
 4-8 Years-------------SPEECH
 8-10 Years-----------BONE GRAFT
 14-18 Years----------JAW , NOSE,SCAR

53. Emotional and Social Issues
 Society often focuses on
appearances, and this can
make childhood — and,
especially, the teen years —
they might experience
painful teasing that can
damage self-esteem.
 Part of the cleft palate and
lip treatment team includes
psychiatric and emotional
support personnel.

54. Ways to support:
 •Try not to focus on the cleft and don't allow it to
define who your child is.
 •Create a warm, supportive, ands accepting home
environment, where each person's individual worth
is openly celebrated.
 •Encourage your child to develop friendships with
people from diverse backgrounds.
 The best way to do this is to lead by example and
to be open to all people yourself.
 •Point out positive attributes in others that do not
involve physical appearance.

55.  Having opportunities to make decisions early on —
like picking out what clothes to wear — lets kids
gain confidence and the ability to make bigger
decisions down the road.
 Consider encouraging your child to present
information about clefting to his or her class with a
special presentation that you arrange with the
teacher.
 Or perhaps your child would like you to talk to the
class. This can be especially effective with young
children.
 If your child does experience teasing, encourage
discussions about it and be a patient listener.

56.  Encourage autonomy by giving your child the
freedom to make decisions and take appropriate
risks, letting his or her accomplishments lead to
a sense of value.
 Provide tools to confront the teasers by asking
what your child would like to say and then
practicing those statements.
 If your child seems to have ongoing self-esteem
problems, contact a child psychologist or social
worker for support and information. Together
with the members of the treatment team,you
can help your child through tough times.

57. Web Sites
 Wide Smiles Web Site
Cleft Lip and Palate Resource
 The Cleft Lip and Palate Association - United Kingdom
This site answers some of the most commonly asked
questions about cleft lip and palate and provides
information on the services and advice offered by CLAPA
- The Cleft Lip and Palate Association.
 Cleft Lip and Palate Association of Ireland
A voluntary group formed to provide support and
information for parents of children affected by cleft lip
and palate and those directly affected by the condition.
 Prescription Parents
Parents helping Parents of children with cleft lip &
palate

58.  Smiles
"SMILES" is a group of dedicated families
who have developed a first-hand understanding
of the needs of children with cleft lip, cleft palate
and craniofacial deformities.
 Cleft Palate Foundation
A non-profit organization dedicated to
optimizing the quality of life for individuals
affected by facial birth defects.

59. THANK YOU
Shake and Bake!