Cleft lip and palate is an abnormal separation of tissues in the oral-facial region that occurs during fetal development. It can be caused by genetic factors, viruses, or other toxins. Symptoms include separation of the lip or palate, nasal distortion, ear infections, feeding difficulties, and speech and dental problems. Treatment involves surgery to repair the cleft, as well as speech therapy and orthodontics. Surgical repair of the cleft lip is usually done at 3-9 months of age, while cleft palate repair is typically between 18-24 months. Non-surgical treatments like dental obturators may also be used. Nursing care focuses on safe feeding and preventing aspiration during intake.

1. Unit 5 :Digestive system
Cleft lip cleft palate

2. Definition
◦A cleft lip or palate
is an abnormal
separation in the
oral-facial region that
happens because tissue
of the mouth or lip
does not form
correctly in fetal
development.

3. Causes
◦Other birth defects
may cause cleft lip or
palate
◦Mutated Inherited
Genes (gene=top,
mutation=bottom)
◦Teratogens (viruses or
other toxins that cause
abnormalities in the fetus)

4. Symptoms
◦Separation of the
lip (picture)
◦Separation of
the palate (roof
of the mouth)
◦Nasal distortion
◦Recurring
ear infections

5. Symptoms (cont.)
◦Failure to gain
weight
◦Nasal
regurgitation when
bottle feeding
◦Poor speech
◦Misaligned teeth
◦Growth
retardation
(picture)

6. TYPES
◦GROUP- 1 .PREALVEOLAR
◦GROUP- 2 . POST
ALVEOLAR
◦GROUP- 3 . COMBINED

8. PATHOPHYSIOLOGY
DUE TO THE ETIOLOGICAL FACTORS
FAILURE OR INCOMPLETE UNION OF THE
EMBRYONIC STRUCTURE OF THE FACE
THE PALATILE PROCESS FUSE ABOUT ONE
MONTH LATER
CLEFT LIP & CLEFT PALATE

9. Diagnostic evaluation
◦ULTRA SONOGRAPHY
◦THOROUGH ASSESSMENT OF
MOUTH
◦IMPAIRED FEEDING
◦DEGREE OF NASAL DEFORMITY

10. Risk Factors
◦Ear infections
top picture
(right=normal,
left=infected)
◦Hearing loss
◦Dental cavities
◦Displaced
teeth (bottom
picture)

11. Risk Factors (cont.)
◦Poor speech
◦Lip deformities
◦Nasal deformities
(cleft lip effect, right)

12. Treatment
◦Treatment involves
many things which
include plastic surgery,
orthodontics, and
speech therapy
(picture is least severe
cleft lip)

13. First Stage-treatment
◦The first part of the
process is surgery.
Surgery is done when
a child is at 3 to 9
months of age. Unless
there is extensive nasal
damage, no more than
one surgery is needed.
(before and after
picture)

14. Management:
Surgical :
a. Cheiloplasty-
-Tennison-Randall triangular flap (Ezplasty)
b. Palatoplasty-
- Millard rotational advancement technique.
c. Latham appliance.

15. Second Stage-therapy
◦The next stage is
therapy. Because of
surgery being done so
early hopefully speech
will form correctly but
because the child has
to adapt, therapy is
advised.

16. Final Stage-orthodontics
◦The final stage of
treatment is
orthodontics. If as the
child gets older teeth
are not straight you
should see an
orthodontist for
treatment (braces).

17. Airway Problems
◦More common in Cleft Palate patients with concomitant structural or
functional anomalies.
◦e.g. Pierre-Robin Sequence
◦Micrognathia, Cleft Palate, Glossoptosis
◦May develop airway distress from tongue becoming lodged in palatal defect

18. Surgical Repair- Cleft Lip
◦Lip Adhesions-
◦2 weeks of age
◦Converts complete cleft into incomplete cleft
◦Serves as temporizing measure for those with feeding problems
◦May interfere with definitive lip repair
◦Less often needed in recent years due to wider variety of specialty feeding
nipples

19. Surgical Repair- Cleft Lip
◦Cleft lip repaired at 10 weeks
◦Rotation-advancement method- Most common in the
U.S.
◦Nine Landmarks
◦Rotation Flap cuts made first
◦Advancement cuts made next
◦Cleft side nasal ala cuts made last

20. Surgical Repair- Cleft Palate
◦Several Techniques- Trend is towards less scarring and less tension on palate
◦Scarring of palate may cause impaired mid-facial growth(alveolar
arch collapse, midface retrusion, malocclusion)
◦Facial growth may be less affected if surgery is delayed until 18-24 months,
but feeding, speech, socialization may suffer.

21. Surgical Repair- Cleft Palate
◦Bardach Method- Two Flap technique
◦Medial incisions made, which separate oral and nasal
mucosa
◦Lateral incisions made at junction of palate and alveolar
ridge
◦Elevate flaps, preserve greater palatine artery.
◦Detach velar muscles from posterior palate
◦Close in 3 layers

23. Non-Surgical Treatment
◦Dental Obturator
◦For high-risk patients or those that refuse surgery.
◦Advantage- High rate of closure
◦Disadvantage- Need to wear a prosthesis, and need to modify prosthesis as
child grows.

24. Nursing management:
□Main problems in this condition is feeding and risk
for aspiration.
Feeding:
□Use soft nipples with large hole feeding bottles (Aseptosyringe,
Medicine broker ,spoons ect ).
□Always keep Childs head elevated while feeding
□Use ESSR technique:
E Enlarge nipple.
S Stimulate sucking reflex.
S Swallow the fluid appropriately.
R Rest after feeding.

25. Conclusions
◦Cleft Lip and Palate are common congenital deformities that often affect
speech, hearing, and cosmesis; and may at times lead to airway compromise.
◦The otolaryngologist is a key member of the cleft palate team, and is in
a unique position to identify and manage many of these problems .