The document provides an overview of cleft lip and cleft palate, defining these congenital malformations and outlining their types, causes, clinical manifestations, and management strategies. It elaborates on the surgical techniques for repair and nursing care involved before and after surgery, as well as potential complications associated with these conditions. Additionally, it includes diagnostic evaluation methods and emphasizes the importance of parental counseling and understanding.

1. Cleft lip and cleft
palate
Presented by :-
Mrs. Sapna Kumari ,M.Sc Nursing
2nd year,Child Health Nursing7/15/2017 1

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3. Introduction
• It is congenital malformation.
• Cleft lip and cleft palate, also known as oro
facial cleft.
• A cleft lip contains an opening in the upper
lip that may extend into the nose. The
opening may be on one side, both sides, or
in the middle.
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4. Cont..
• A cleft palate is when the roof of the mouth
contains an opening into the nose.
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5. Cleft Lip
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6. cleft lip
It results from failure of maxillary process
to fuse with nasal elevations on frontal
prominence.
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TYPES

8. Before surgery and after surgery
of cleft lip
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9. Cleft lip Unilateral incomplete

10. Unilateral complete

11. Bilateral complete

12. Cleft palate
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13. cleft palate
• Cleft palate is a condition in which the two
plates of the skull that form the hard palate
(roof of the mouth) are not completely
joined.
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TYPES

15. Incomplete cleft palate

16. Unilateral complete lip and
palate

17. Bilateral complete lip and palate

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causes

19. Causes
• Genetic
• Maternal factors i.e viral infections during
5th to 12th weeks of gestation
• Exposure to X-ray
• The cause in most cases is unknown.
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20. Cont..
• Risk factors include smoking during
pregnancy, diabetes, an older mother,
obesity, and certain medications such as
some used to treat seizures.
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21. CLINICAL MANIFESTATIONS
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22. • Clinical manifestations in cleft lip and cleft palate
• In cleft lip:-
• Complete separation extending to the floor of the nose
• Separation mainly of 2 types:- Unilateral , Bilateral
• In cleft palate:-
• cleft palate defects are less obvious when they occur without a cleft lip and may not be detected at
birth.
• Cleft of the hard palate form a continuous opening between the mouth and nasal cavity. It also
may be of unilateral or bilateral .
• Common 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
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23. PATHOPHYSIOLOGY
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24. Pathophysiology of Cleft lip
The embryological development of the upper lip
and nose occurring between the 3rd and 8th week of
gestation, with lip development between the 3rd
and 7th weeks
A cleft lip is formed when normal development is
interrupted before 7th week of gestation
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25. Pathophysiology of cleft palate
The development of the palate occurs between the
5th and 12th weeks of gestation.
Cleft palate is formed when normal palatal
development is interrupted before the 12th week of
gestation
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26. DIAGNOSTIC EVALUATION
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27. Diagnostic evaluation
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• Cleft lip and cleft palate are usually
diagnosed at birth or new born assessment.
• Cleft palate is identified through visual
examination of the oral cavity or when
examiner places a gloved finger in the
palate

28. THERAPEUTIC
MANAGEMENT
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29. Surgical management
In cleft–lip:-Surgical repair of the defect of
the lip is done, preferably at 2-3 months of
age. Most physicians adhere to the “rule of
ten”: the infant must be 10 weeks old,
weight 10 pounds, and have hemoglobin of
10.The operation termed as cheiloplasty.
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30. Cont..
The two most common procedures for repair
of cleft lip:-
• Tennison-Randall triangular flap(Z-Plasty)
• Millard rotationsl advancement technique
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31. Z- Plasty
Z-plasty may be done to lengthen the soft palate
and decrease nasal escape of speech sounds. This
technique is used to improve the functional and
cosmetic appearance of the scars.
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33. Millards Rotational
Advancement Technique
• The blue lines indicate incisions.
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34. Movement of the flaps; flap A is moved
between B and C. C is rotated slightly
while B is pushed down.
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35. Cont….
In cleft –palate:-
• Palatoplasty, the surgical reconstruction of
the palate is done with repair of the cleft, at
about age of 1-2 years of age. It should be
done before child develops defective
speech.
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38. Cont..
• The most common technique to repair cleft
palate :
• Veau-Wardill-Kilner V-Y pushback
procedure
• Furlow double- opposing Z-plasty
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39. Nursing management
• 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 child
• Assess the need for surgical correction
• Assess the parents understanding of the defect and
need for the surgery.
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40. Nursing diagnosis
• Altered nutrition less than body
requirements
• Risk for infection
• Risk for aspiration
• Ineffective breathing pattern
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41. Cont…
• Preoperative nursing management :-
• Feeding the child: sterile breast feed , burp
• Provide right position
• Airway clearance
• Hygienic care to child
• Timings- follow “rule of ten“ for surgery
• Complete all immunization accordingly before
surgery
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42. Cont…
Post-operative nursing management :-
• Assess the vital signs of child regularly
• Reposition the infant every 2 hourly
• Clean the suture line with the saline solution and a
cotton tipped applicator
• Give general post operative care to child
• Provide side- lying position to drain secretions and
prevent aspiration
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43. cont..
• Provide elbow restrain
• Maintain aseptic dressing with precautions
• Feeding with medicine dropper
• Parental counseling is an important thing and
advise about care , feeding and follow up etc
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44. Logan’s bow
• It is placed over the upper lip and taped to
the infant’s cheek to prevent tension at the
suture line
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45. COMPLICATIONS
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46. • Complications
• Immediate problems:-
• feeding problem due to ineffective sucking resulting in under
nutrition
• Aspiration of feed resulting in respiratory infections
• Parental anxiety due to defective appearance of the infant
• Long term problems:-
• Recurrent infections especially otitis media.
• Disturbed parent child relationship and maladjustment with non
acceptance of the infant
• Impairment of speech
• Mal placement of teeth
• Hearing problems due to oral malformation especially in cleft palate.
• Impaired body image due to altered shape of face and oral
cavity.
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47. Summarization
Today I discussed about cleft lip and cleft
palate:-
• Introduction of cleft lip and cleft palate
• Definition of cleft lip and cleft palate
• Types of cleft lip and cleft palate
• Sign and symptoms
• Pathophysiology of cleft lip and cleft palate
• Diagnostic evaluation
• Therapeutic management
• Nursing management
• Complications
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48. Recaptualization
• Define cleft lip and cleft palate
• Mention the causes of cleft lip and cleft palate
• Enlist the sign and symptoms of cleft lip and cleft palate
• Explain patho physiology of cleft lip and cleft palate
• Enlist diagnostic evaluation done to identify cleft lip and cleft
palate
• Explain surgical management of cleft lip and cleft palate
• Mention the complications of cleft lip and palate
• Explain nursing management for cleft lip and cleft palate
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49. Bibliography
• Datta P. Pediatric nursing,2nd edition. Jaypee
Publishers, Pp.449-51.
• Bindler R.and Ball J. pediatric nursing and caring for
children,2nd edition,Appleton and lange Stamford,
Connecticut publisher,Pp.593-603.
• Wilson D. Hockenberry , J.Marilyn, Wongs essentials
of pediatric nursing, 1st edition , Elsevier
publishers, Pp.687-90.
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50. Thank you for cooperation 
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