it is very useful for nursing students

1. CLEFT LIP AND CLEFT PALATE

2. Definition
• Cleft lip is a gap or indentation in the lip or
split continued upto the nostril due to the
failure of fusion of the maxillary and medial
nasal process.
• Cleft palate is the condition in which the two
plates of the skull that forms the hard palate
are not completely joined due to the failure of
fusion of the lateral Palatine processes,nasal
septum and medial palatine process.

3. Embryology
• Primary palate forms during 4th – 7th week of
gestation when 2 maxillary processes and 2
medial nasal processes fuse.
• Secondary palate forms during 6th – 9th week
of gestation when palatal shelves change from
vertical to horizontal position and fuse.

4. Etiology
• Genetic
• Environmental teratogens
• Maternal intrauterine conditions
• Advanced paternal age
• Unknown

5. Classification
• Group 1:only cleft lip.Unilateral,bilateral or
midline.
• Group 2:only cleft palate.unilateral.bilateral or
submucosal.
• Group 3:includes cleft lip,alveolus and cleft
palate-unilateral,bilateral or midline.

7. Clinical Features
• Cleft lip: Notched vermilion border and may
involve alveolar ridge
• Cleft palate:Nasal distortion,exposed nasal
cavities.
• Misaligned teeth.
• Passage of milk through nasal passages during
feeding.
• Speech difficulties,poor wt gain and failure to
thrive

8. Diagnosis
• Newborn examination
• Palpate palate
• In utero USG

9. Complications and problems
• Immediate problems
Feeding difficulty
Difficult breathing
Increased chance of aspirations

10. • Long term problems
Recurrent ear infection and hearing loss
Speech difficulty
Malocclusion of teeth
Maxillary cleft

11. Management
• Modified feeding:
Breast feeding- can given with extra time and
patience
Upright position
Burp frequently between feeds

12. Bottle feeding- Large hole bottles designed for
cleft
Haberman feeder-valve to control air entry,back
flow.
NUK nipple made for cleft can be connected in
normal bottle

13. Haberman feeder

14. NUK nipple

15. Non surgical management
• Dental obturator to realign the parts of the
palate.

16. Surgical management
• Cleft lip repair or cheiloplasty:
Lip adhesion done at 2 weeks
Cleft lip repair done at 10 weeks of age following
rule of 10-
10 weeks old,wts 10 pounds(4.5kg),10 gm Hb.
Millard repair,Randall-Graham etc

17. • Cleft palate or palatoplasty
9 and 12 months of age.
V-Y pushback,two flap palatoplasty,four flap
palatoplasty etc
Complications:
Oro nasal fistula, velopharyngeal insufficiency.

18. • Speech and hearing treatments:
Tympanostomy tube in eardrum to aerate
middle ear to increase hearing ability.
Speech problems- speech language pathologist

19. Nursing management
• Pre operative:
• Assessment
• Interventions:promote adequate feeding and
prevention of aspiration
• Family support and education

20. • Post operative:
• Assessment
• Interventions-
Feeding,Preventing trauma
preventing infection
minimising pain
health education