Cleft Lips And Cleft Palate | hare lip

• Cleft lips and Cleft palate is congenital anomalies that occur as a result of the failure of soft tissue or bony structure to fuse during the embryonic periods.
• Cleft lips and palate may be complete and partially.
• Cleft lips are also known as “hare lip“

Cleft Lips(hare lip)

• Also known as CHEILOSCISIS
• Cleft lips occur when the maxillary process is failed to fuse with the medial nasal process
• It may be unilateral or bilateral
• It occurs during 5-12 weeks of gestational age
• Incidence is 1 in 800 live births

Cleft Palate

• Also known as Palatoschisis
• Cleft palate occurs when the lateral palatine process is failed to fuse
• The severity of cleft palate is involve Uvula to the nasopalatine foramen
• It occurs during 12-14 weeks of gestational age
• Incidence 1 in 2000 live birth

  

Etiology of cleft lip and palate

• Maternal smoking and exposure to passive smoke
• Drugs – Accutane, Phenytoin, Warfarin, ethanol etc.
• Maternal folic acid deficiency
• Hereditary and environmental factors
• Exposure to radiation and rubella virus.
• Chromosomal abnormalities
• Teratogenic factors
• Prolonged Maternal Anemia

Clinical features of cleft lip and palate

• Failure to weight gain
• Feeding problem
• Poor Growth
• Repeated ear infection and speech difficulty
• Dental abnormalities
• Middle ear fluid buildup and hearing loss
• Psychological problem

Management Cleft Lips And Cleft Palate

1. Medical Cleft Lips And Cleft Palate hare lip

• Firstly nurse assesses the physical Examination for cleft lips and gloved fingers use for cleft plate
• Assess the ability to suck, swallow, and breathe
• Slow and small quantity feeding is provided
• Palade spoon, Medicine dropper, and syringe with catheter etc, use for feeding.
• Intermittent burping during the feeding
• Provide rest
• Baby, semi upright position provide during feeding and side lateral position after feeding.
• Bulb syringe or suction apparatus keep near to bed side.

2. Surgical Cleft Lips And Cleft Palate hare lip

1. Cheiloplasty – For Cleft lips
2. Palatoplasty- For Cleft plate

1. Cheiloplasty –

• It is a plastic surgical procedure for repair the cleft lips
• The procedure is done at 3-6 months
• There is minimally invasive surgical procedure
• Z shape suturing use in cheiloplasty to minimize the changes of separation of a suture.
• Use 10 “rainbow” (C-shape) after the surgery to minimize the pressure on suture.
• The prone position should be avoided in cheiloplasty-treated children. Only lateral and semi-upright positions provide
• After feeding, the suture line is cleaned with NS sterile water, etc.

2. Palatoplasty –

• Palatoplasty is a surgical procedure for the correct the palate with cleft palate person.
• Palatoplasty procedure done at 6-18 months of age.
• Palatoplasty procedure fill the gap of palate by MUCO PERIOSTEUM FLAP
• Oral packing should be done after the surgery.
• Prone position recommended for palatoplasty patient.
• Complication
• Recurrent Otitis media (Hearing loss) – due to dysfunction of Eustachian tube.
• Feeding problem
• Speech Problem
• Recurrent Respiratory tract infection
• Nursing Management
• Nurse should carefully perform the head to toe assessment and assess the cleft lips and cleft palate deformity.
• Nurses assess the client lips by visually and cleft palate by gloved figures.
• Nurse assess the feeding pattern of the child
• Assess the need for the surgical correction
• Airway clear and provide proper position
• Nurse encourage the parents to accept the child condition
• Provide the complete immunization before the surgery
• Elbow and jacket restrain provide after the surgery
• Avoid the use of oral suctioning, Tounge depressor, oral temp., thermometer etc.
• Don’t allow the child to brush and do not allow hard food to baby
• Avoid the contact of the sharp object to the suture line.

• KEY POINTS
• The maxillary process is failed to fuse with the medial Nasal process is known – Cleft lips
• Cleft palate Occur during the – 12-14 weeks of gestational age
• Priority Nursing management in cleft lips and cleft palate – Clearance of airway
• Which type of restrain use in the cleft plate and the cleft lips – Elbow and jacket Restrain
• Which position is provided during the Feeding baby with Cleft lips and cleft Palate – Semi-upright Position