1. Cleft Lip & Palate
PRESENTED BY:
A.PRIYADHARSHINI M.Sc (N)
LECTURER,
JAI INSTITUTE OF NURSING AND
RESEARCH, GWALIOR

2. INTRODUCTION:
 Cleft lip (cheiloschisis) and cleft
palate (palatoschisis), which can also occur
together as cleft lip and palate, are variations
of a type of clefting congenital deformity caused
by abnormal facial development
during gestation.
 A cleft is a fissure or opening—a gap.
 It is the non-fusion of the body's natural
structures that form before birth.

3. CLEFT LIP- DEFINITION:
 Cleft lip is formed in the top of the lip as either
a small gap or an indentation in the lip (partial or
incomplete cleft) or it continues into the nose
(complete cleft).
 Lip cleft can occur as a one sided (unilateral) or
two sided (bilateral).
 It is due to the failure of fusion of the maxillary
and medial nasal processes(formation of the
primary palate).

4. INCIDENCE:
 Approximately 1 in 700 children born have a
cleft lip and/or a cleft palate.
 Left side unilateral cleft is the most common.

5. Unilateral incomplete Unilateral complete Bilateral complete

6. 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.
 In most cases, cleft lip is also present. Cleft
palate occurs in about one in 700 live births
worldwide.
 Palate cleft can occur as complete or incomplete

7. CONTD…
 When cleft palate occurs, the uvula is usually
split.
 It occurs due to the failure of fusion of the
lateral palatine processes, the nasal septum,
and/or the median palatine processes (formation
of the secondary palate).
 The hole in the roof of the mouth caused by a
cleft connects the mouth directly to the
nasal cavity.

8. Incomplete cleft palate Unilateral complete lip and palate Bilateral complete

9. Etiology
 Genetic
 Environmental agents-seasonal causes
(such as pesticide exposure);
 Maternal diet and vitamin intake;
 parental exposure to lead
 Medications- phenytoin, sodium
valporate and methotrexate
 Cigarette smoking during pregnancy
 Alcohol during pregnancy
 Folate deficiency

10. SIGNS AND SYMPTOMS:
 Split in lip or palate
 Symptoms related to location of cleft:
◦ Hard & soft palate: Facial defect
◦ Soft palate: leaking of ingested liquids from the nose
◦ Hard palate: weak, dysfunctional suck, trouble
swallowing, gagging, choking

11. Prenatal Diagnosis
 Diagnosed until the soft tissues of the fetal face
can be clearly visualized sonographically (13 to
14 weeks).
 The majority of infants with cleft lip also have
palatal involvement:

12. Prenatal Diagnosis

13. CLEFT LIP- TREATMENT:
 Within the first 2–3 months after
birth, surgery is performed to close the cleft lip.
 While surgery to repair a cleft lip can be
performed soon after birth, often the preferred
age is at approximately 10 weeks of age,
following the "rule of 10s" (the child is at least
10 weeks of age; weighs at least 10 pounds, and
has at least 10g hemoglobin).

14. CONTD…
 If the cleft is bilateral and extensive, two
surgeries may be required to close the cleft, one
side first, and the second side a few weeks later.
 The most common procedure to repair a cleft
lip is the Millard procedure .

15. Cleft lip repair. The edges of the cleft between the lip and nose are cut (A and
B). The bottom of the nostril is formed with suture (C). The upper part of the lip
tissue is closed (D), and the stitches are extended down to close the opening
entirely (E).

17. CLEFT PALATE-TREATMENT
 Often a cleft palate is temporarily covered by
a palatal obturator (a prosthetic device made to
fit the roof of the mouth covering the gap).
 Cleft palate can also be corrected by surgery,
usually performed between 6 and 12 months.

18. CONTD..
 One of the new innovations of cleft lip and cleft
palate repair is the Latham appliance.
 The Latham is surgically inserted by use of pins
during the child's 4th or 5th month. After it is in
place, the doctor, or parents, turn a screw daily
to bring the cleft together to assist with future
lip and/or palate repair.

19. Speech and hearing:
 A tympanostomy tube is often inserted into
the eardrum to aerate the middle ear. This is
often beneficial for the hearing ability of the
child.
 Children with cleft palate typically have a variety
of speech problems.
 Difficulty in pronouncing /p/, /b/, /t/, /d/,
/s/, /z/, etc.This type of errors typically resolve
after palate repair.

20. Feedings
 Infants with CL/P have few feeding problems.
 If the cleft involves the hard palate, the infant is
usually not able to suck efficiently.
 The infant should be held in a nearly sitting
position during feeding
 Prevents flowing to the back into the nose.
 Should be burped frequently, (q 3-4min).

21. Feedings
 It is important to keep
the cleft clean
 Breastfeeding is
extremely challenging.

22. Special Needs Feeder / Haberman
Feeder

23. PIGEON FEEDER:

25. NURSING DIAGNOSIS:
 Risk for aspiration related to opening of the
palate.
 Imbalanced nutrition less than body requirement
related to poor food intake.
 Impaired communication related to problem
with the production of sound.
 Deficient knowledge (mother)regarding proper
feeding techniques.

26. THANK YOU