Cleft lip, also known as cheiloschisis, is a congenital deformity characterizedbyasplitoropeningintheupperlipduetothefailureoffusion of themaxillaryprocesses.Cleft lipcanbeunilateral orbilateral andmay occuralongwithcleftpalate. Head end of Embryo(30 days) z Cleft palate, also known as palatoschisis, is a congenital condition characterizedbyanopeningintheroofof themouthcausedbythefailureof fusionof thepalatineprocesses.Thisconditioncan involve thehardpalate, softpalate,orboth. z  Cleft Lip: The incidence of cleft lip, withorwithout cleft palate, is approximately1 in1,000 livebirths. It ismorecommon inmales than females.  CleftPalate:Theincidenceofcleftpalatealoneisabout1in2,500live births.Thisconditionismorecommoninfemalesthanmales. z Genetic Factors:  Family history of clefts can increase the risk.  Mutationsin geneslinked to facial development.  Chromosomal abnormalities associated with conditions like trisomy 13 and Van der Woude syndrome. Theexactcauseofcleftlipandcleftpalateisunknown;however,theyare believedduetoacombinationofgeneticandenvironmentalfactors. EnvironmentalFactors:  Maternal health issues such as diabetes and obesitycontribute.  Nutritional deficiencies, especially folic acid, duringpregnancy.  Substanceuse, including alcohol and tobacco, bythemotherduringpregnancy.  Exposure to X-rays or radiation during pregnancy.  Overuse of certain medications like anticonvulsantsduringpregnancy. z Cleft lip and cleft palate result from abnormal fusion of facial structures during embryonic development. The lip forms from the merging of the medial nasal processes and maxillary processes, while the palate develops from the fusion of palatine shelves. Disruptions in these processes can lead to incomplete formation, resulting in gaps. These malformations can lead to problems such as difficulty eating, speech delays, ear infections, and orthodontic issues. z  FeedingDifficulties: Infantsmaystruggletocreateaproperseal forbreastfeedingorbottle feeding,leadingtoinadequatenutrition.  SpeechDelays:Cleftscanaffectthedevelopmentofnormalspeechpatterns,requiringspeech therapy.  EarInfections:IncreasedriskofotitismediaduetoEustachiantubedysfunction,whichcan leadtohearingloss.  RespiratoryInfections:Higher susceptibility torespiratoryinfectionsdue tocompromised airwayfunction.  DentalProblems:Misalignmentofteeth,missingteeth,andincreasedriskofcavities.  GrowthandDevelopmentIssues:Potential impactonoverallgrowthif feedingdifficulties aresignificant. z  Prenatal Ultrasound: Can identify physical abnormalities, such as cleft lip/palate, as early as the second trimester.  Physical Examination: A thorough examination at birth can confirm the presence of cleft lip/ palate. z  After birth, infants with cleft lip and/or cleft palate require caref

1. z
CLEFT LIP &
CLEFT PALATE
Mr. Pradeep Abothu, M.Sc (N), PhD Scholar,
Associate Professor, Dept. of Child Health(N)
ASRAM College Of Nursing

2. z
CLEFT LIP
Cleft lip, also known as cheiloschisis, is a congenital deformity
characterized by a split or opening in the upper lip due to the failure of fusion
of the maxillary processes. Cleft lip can be unilateral or bilateral and may
occur along with cleft palate.
Head end of Embryo(30 days)

3. z
CLEFT PALATE
Cleft palate, also known as palatoschisis, is a congenital condition
characterized by an opening in the roof of the mouth caused by the failure of
fusion of the palatine processes. This condition can involve the hard palate,
soft palate, or both.

4. z INCIDENCE
 Cleft Lip: The incidence of cleft lip, with or without cleft palate, is
approximately 1 in 1,000 live births. It is more common in males than
females.
 Cleft Palate: The incidence of cleft palate alone is about 1 in 2,500 live
births. This condition is more common in females than males.

5. z
ETIOLOGY
Genetic Factors:
 Family history of clefts can increase the risk.
 Mutations in genes linked to facial development.
 Chromosomal abnormalities associated with conditions like trisomy 13
and Van der Woude syndrome.
The exact cause of cleft lip and cleft palate is unknown; however,
they are believed due to a combination of genetic and environmental factors.

6. Environmental Factors:
 Maternal health issues such as diabetes and obesity
contribute.
 Nutritional deficiencies, especially folic acid,
during pregnancy.
 Substance use, including alcohol and tobacco, by
the mother during pregnancy.
 Exposure to X-rays or radiation during pregnancy.
 Overuse of certain medications like anticonvulsants
during pregnancy.

7. z
PATHOPHYSIOLOGY
Cleft lip and cleft palate result from abnormal fusion of facial structures during
embryonic development.
The lip forms from the merging of the medial nasal processes and maxillary processes,
while the palate develops from the fusion of palatine shelves.
Disruptions in these processes can lead to incomplete formation, resulting in gaps.
These malformations can lead to problems such as difficulty eating, speech delays, ear
infections, and orthodontic issues.

8. z
COMPLICATIONS
 Feeding Difficulties: Infants may struggle to create a proper seal for breastfeeding or bottle
feeding, leading to inadequate nutrition.
 Speech Delays: Clefts can affect the development of normal speech patterns, requiring
speech therapy.
 Ear Infections: Increased risk of otitis media due to Eustachian tube dysfunction, which can
lead to hearing loss.
 Respiratory Infections: Higher susceptibility to respiratory infections due to compromised
airway function.
 Dental Problems: Misalignment of teeth, missing teeth, and increased risk of cavities.
 Growth and Development Issues: Potential impact on overall growth if feeding difficulties
are significant.

9. z
DIAGNOSTIC EVALUATION TESTS
 Prenatal Ultrasound: Can identify physical abnormalities, such as cleft
lip/palate, as early as the second trimester.
 Physical Examination: A thorough examination at birth can confirm the
presence of cleft lip/ palate.

10. z
TREATMENT
 After birth, infants with cleft lip and/or cleft palate require careful
management to ensure their health and prepare them for surgical interventions.
 A multidisciplinary healthcare team is involved, including pediatricians,
speech and feeding specialists, nutritionists, surgeons, and prosthodontists, all
coordinating to monitor overall health and development.
 Once the child is at least 5 kg by 3 months, has an absence of respiratory
infections, and demonstrates adequate nutritional status, the child is
considered healthy enough to proceed with surgery.

11. z
SURGICAL MANAGEMENT
 Cleft Lip Repair: known as cheiloplasty, is typically performed between 3 to
6 months of age. During the procedure, an incision is made along the natural
contour of the lip, allowing the surgeon to bring the lip edges together and
suture them using techniques such as Z-plasty for improved aesthetics, other
techniques that can be used are Millard repair, Randall-Graham procedure,
and Rose-Thompson procedure.

12. z
SURGICAL MANAGEMENT
 Cleft Palate Repair: known as palatoplasty, the procedure is usually
conducted between 9 to 18 months of age. An incision is made in the oral
mucosa along the cleft, and tissue flaps from the hard and soft palates are
mobilized and sutured to close the cleft, often utilizing the V-Y pushback
technique.

13. NURSING
MANAGEMENT

14. z
Care of the Child immediately after birth:
• Evaluate the extent of the cleft lip and/or palate.
• Monitor for feeding difficulties and signs of aspiration.
• Assess for associated anomalies or syndromes.
• Use specialized feeding bottles and nipples designed for
cleft lip/palate.
• Encourage upright positioning during feeds to reduce the
risk of aspiration.

15. z
• Give the child enough time to swallow and burp in between feeds.
• Consider using a palatal obturator to help with feeding.
• Monitor for complications, such as otitis media or dental issues, and refer to
specialists as needed.
• Teach parents proper feeding techniques and the use of specialized
bottles/nipples.
• Provide emotional support and encourage bonding with the child.

16. z
Preoperative Care:
• Conduct a thorough preoperative assessment and ensure all preoperative
investigations are completed.
• Keep the child NPO.
• Educate parents about the surgical procedure, expected outcomes, and
postoperative care.
Postoperative Care:
• Monitor vital signs and surgical site for signs of infection or bleeding.
• Position the child in semi upright position to prevent aspiration.
• Administer pain management as prescribed.
• Use elbow restraints if necessary to prevent the child from touching or
pulling at the surgical site.

17. z
• Apply a Logan's bow or other protective
devices as directed by the surgeon.
• Start with clear liquids and gradually advance
to a soft diet as tolerated.
• Use a syringe or soft-tipped feeder to avoid
putting pressure on the surgical site.
• Teach parents how to care for the surgical site, including cleaning
and applying any prescribed ointments.
• Instruct parents on signs of infection to watch for and when to
seek medical advice.

18. z
NURSING DIAGNOSIS
 Impaired Nutrition less than Body Requirements related to feeding
difficulties.
 Risk for Aspiration related to anatomical defects.
 Delayed Growth and Development related to inadequate nutritional intake.
 Risk for Infection related to surgical interventions.
 Acute Pain related to surgical intervention.
 Knowledge Deficit related to lack of information about proper feeding
techniques and postoperative care.