PEDIATRIC NURSING

1. CLEFT LIP AND CLEFT PALATE
P.THIRUNAGLINGA PANDIYAN
M.Sc.,(N).,M.A., D.Pharm.,
School of Nursing
Madurai Medical College
Madurai

2. INTRODUCTION
• The dictionary meaning of Cleft is a Crack, Fissure, Split or
Gap.
• Cleft lip and palate is a congenital birth defect which is
characterized by complete or partial cleft of lip and/or palate
• Not life threatening unless associated with other syndrome

3. CLEFT LIP
• A cleft lip is an opening or split in the upper lip that occurs
when developing facial structures in an unborn baby don't
close completely.
• Cleft lip may be unilateral or bilateral.
• A cleft lip can be on one or both sides of the lip or in the
middle of the lip
• More often in boys than girls

4. ANATOMY OF LIP

5. CLEFT PALATE
• A cleft palate is an opening or split in the roof of the
mouth that occurs when the tissue doesn't fuse
together during development in the uterus .

6. ANATOMY OF PALATE

7. EMBRYOLOGY – DEVELOPMENT OF
LIP AND PALATE
• Mandibular arch plays a role in development of
naso maxillary complex
• During 4- 5 th week of gestation Mandibular arch
gives rise to form maxillary process
• With the formation of nasal pits, frontonasal process
gets divided into a medial nasal process and two
lateral nasal processes.

8. EMBRYOLOGY – DEVELOPMENT OF
LIP AND PALATE
• Maxillary process fuse with medial and lateral nasal
processes to form Upper Lip
• Lower Lip is formed by the fusion of Mandibular
process of two sides.
• Failure of merging between the medial nasal and
maxillary processes at 5 weeks’ gestation, on one
or both sides results in Cleft Lip

9. EMBRYOLOGY – DEVELOPMENT OF
LIP AND PALATE
• Development of Palate begins in 6th week
• Primary Palate develops from Medial Nasal Process
• Secondary Palate develops from Maxillary Process
• Fusion of Palatal Shelves begin at 8th week which
continues till 12 th week.

10. EMBRYOLOGY – DEVELOPMENT OF
LIP AND PALATE
• Initially the Palatal shelves are covered by an epithelial
lining.
• The connective tissue of the Palatal shelves intermingle
with each other resulting in fusion of Primary and
Secondary palate
• Defective growth of Palatal shelves and Lack of

11. CAUSES
• Prenatal infection
• Drugs during antenatal period
• Poor nutrition during antennal period
• Advanced maternal age
• Radiation exposure

12. TYPES OF CLEFT LIP
• Unilateral - One side split of lip
• Bilateral cleft lip – Split of lip on both sides

13. TYPES OF CLEFT PALATE

14. SIGNS AND SYMPTOMS OF
CLEFT LIP AND CLEFT PALATE
• Difficulty with feedings
• Difficulty swallowing, with potential for liquids or foods
to come out the nose
• Nasal speaking voice
• Chronic ear infections

15. TREATMENT
• SURGERY
• Surgery to correct Cleft Lip and Palate is based on the child's
particular situation.
• Following the initial cleft repair and follow-up surgeries to
improve speech or improve the appearance of the lip and
nose.
• Surgeries typically are performed in this order:
• Cleft Lip Repair — Within the first 12 months of age
• Cleft Palate Repair — By the age of 18 months

16. TREATMENT
CHEILOPLASTY
• 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

17. TREATMENT
• PALATOPLASTY
• Cleft Palate Repair
• Procedures used to close the
separation and rebuild the roof
of the mouth (hard and soft
palate).
• The surgeon makes incisions on
both sides of the cleft and
repositions the tissue and
muscles. The repair is then
stitched closed.

18. NURSING MANAGEMENT
Pre Operative Care
•Prepare the child for surgical repair
•Explain the impact of defect
•Assist the mother with breast feeding

19. NURSING MANAGEMENT
Pre Operative Care
• Stimulate let down reflex manually or by breast pump
• Modify feeding technique to be followed
• Use specific feeding appliances
• Hold the child in upright position to prevent aspiration

20. NURSING MANAGEMENT
Post Operative Care
• Assess the vital signs
• Position to allow the drainage of mucous
• Maintain the lip protective devices ( Logan’s bow)
• Use non traumatic feeding

21. NURSING MANAGEMENT
Post Operative Care
• Restrain the elbow
• Prevent vigorous crying
• Non vigorous sucking
• Teach the parents regarding cleaning and restraining
• Monitor IV fluids

22. NURSING MANAGEMENT
NURSING DIAGNOSES
1. Imbalance nutrition less than body requirements
2. Ineffective airway clearance related to tracheobronchial
aspirations of feeding
3. Anxiety related to congenital defect
4. Knowledge deficit of care taker
5. Risk for injury related to internal physical factor

23. THANK YOU