29088241 cleft lip and cleft palate
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CLEFT LIP
AND CLEFT
PALATE
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COMPARISONFEATURES CLEFT LIP CLEFT PALATE
Incidence Common among males 1/1000 Common among females1/2500
Genetic Multifactoral Multifactoral
Description is an abnormality in which thelip does not completely form
during fetal development.
occurs when the roof of themouth does not completely
close, leaving an opening that
can extend into the nasal
cavity.
Pathophysiology result when tissues fail tofuse
result when tissues fail tofuse
Surgical repair Cheiloplasty (logan bow) Palatoplasty
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FEATURES CLEFT LIP CLEFT PALATE
Preoperative care usually occurs at 1 to 3 monthsof age
usually performed between 6and 18 months of age
Position post op Supine (on his back)
-to avoid injury of theoperative site
Prone (on her abdomen)
-to facilitate drainage ofmucus and blood
Feeding post op No sucking
Use Breck feeder/rubbertipped medicine dropper
No sucking
Use wide-bowl spoon or papercup.
Nursing care post op Elbow restraint
Lessen crying(may cause stress
on suture line) Croup/mist tent (to preventrespiratory distress and tokeep secretions moist)
Same
Long term concern Bonding attachment
Social adjustment
Defective speech, refer tospeech therapist
Abnormal dentition;
Refer to orthodontist Hearing loss; refer toaudiologist
Possible Complication feeding difficulties
ear infections and hearing loss
speech and language delay
dental problems
feeding difficulties
ear infections and hearing loss
speech and language delay
dental problems
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Description
1. Cleft lip (cheiloschisis) is a congenital anomaly
that occurs at a rate of 1 in 800 births.
a. If the cleft does not affect the palate structure
of the mouth it is referred to as cleft lip.
b. 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)
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c. Cleft lip can be unilateral or bilateral.
d. It is due to the failure of fusion of themaxillary and medial nasal processes
(formation of the primary palate).
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Cleft palate (palatoschisis) is a congenital anomaly
that occurs in approximately 1 of every 2000
births, and it is more common in boys than girls.
a. It is a condition in which the two plates of the
skull that form the hard palate (roof of the
mouth) are not completely joined.b. It ranges in severity from soft palate
involvement alone to a defect including the hard
palate and portions of the maxilla.c. Cleft palate may or may not be associated with
cleft lip.
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Etiology
1. Many factors are associated with thedevelopment of cleft lip and cleft palate, andcleft lip with or without cleft palate are
developmentally and genetically differentfrom isolated cleft palate.
2. Most cases appear to be consistent with theconcept of multifactorial inheritance asevidenced by an increase incidence inrelatives and monozygotic twins
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Pathophysiology
1.During embryonic development the lateral and
medial tissues forming the upper lip palates
fuse between weeks 7 and 8 of gestation; the
palatal tissues forming the hard and soft
palates fuse between weeks 7 and 12
gestation.
2. Cleft lip and cleft palate result when thesetissues fail to fuse.
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Assessment findings
1. Clinical manifestations
a. Cleft lip and cleft palate are readily apparent atbirth. Careful physical assessment should beperformed to rule out other midline birth defects.
b. Cleft lip and cleft palate appear as incomplete orcomplete defects, and may be unilateral orbilateral.
2. Laboratory and diagnostic study findings.Obstetric ultrasound will reveal cleft lip while theinfant is in utero.
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Nursing management
1. Assess for problems with feeding, breathing
parental bonding, and speech.
2. Ensure adequate nutrition and prevent
aspiration.
a. Provide special nipples or feeding devices (eg,
soft pliable bottle with soft nipple with
enlarged opening) for a child unable to suck
adequately on standard nipples.
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b. Hold the child in a semi upright position;
direct the formula away from the cleft and
toward the side and back of the mouth to
prevent aspiration.
c. Feed the infant slowly and burp frequently to
prevent excessive swallowing of air and
regurgitation.
d. Stimulate sucking by gently rubbing the
nipple against the lower lip.
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Support the infant’s and parents’ emotional
and social adjustment.
a. Help facilitate the family’s acceptance of the
infant by encouraging the parents to express
their feelings and concerns and by conveying
an attitude of acceptance toward the infant.
b. Emphasize the infant’s positive aspects and
express optimism regarding surgical
correction.
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Provide preoperative care.
a. Depending in the defect and the child’s general
condition, surgical correction of the cleft lip usually occurs at 1 to 3 months of age; repair of the cleft palate is usually performed between 6and 18 months of age. Repair of the cleft palate
may require several stages of surgery as the childgrows.
b. Early correction of cleft lip enables more normal
sucking patterns and facilitates bonding. Earlycorrection of cleft palate enables development of more normal speech patterns.
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Delayed closure or large defects may require theuse of orthodontic appliances.
d. The responsibilities of the nurse are to:1. Reinforce the physician’s explanation of surgical
procedures.
2. Provide mouth care to prevent infection.
Provide postoperative care.
a. Assess airway patency and vital signs; observe for
edema and respiratory distress.b. Use a mist tent, if prescribed, to minimize
edema, liquefy secretions, and minimize distress.
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Position the child with cleft lip on her back, in an infant seat, or propped on a
side to avoid injury to the operative site; position the child with a cleft
palate on the abdomen to facilities drainage.
d. Clean the suture line and apply an antibacterial ointment as prescribed to
prevent infection and scarring. Monitor the site for signs of infection.
e. Use elbow restraints to maintain suture line integrity. Remove them every 2
hours for skin care and range-of-motion exercises.
f. Feed the infant with a rubber-tipped medicine dropper, bulb syringe, Breck
feeder, or soft bottle-nipples, as prescribed, to help preserve sutureintegrity. For older children, diet progresses from clear fluids; they should
not use straws or sharp objects.
g. Attempt to keep the child from putting tongue up to palate sutures.
h. Manage pain by administering analgesic as prescribed.
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