Cleft Lip and/or Cleft Palate

Presented By : Jenny Orcine

 Cleft lip and/or palate
Cleft lip and cleft palate are birth defects that occur when the
lip or mouth do not form properly during pregnancy. This
type of birth defect also is called a facial anomaly. A child
can have only a cleft lip, only a cleft palate, or both together.
A cleft lip involves an opening from the upper lip to one or
both nostrils. With a cleft in the palate, the opening in the
roof of the mouth connects the oral and nasal cavities.
Children with cleft lip or cleft palate often have problems
eating and talking.
 Cleft Lip -is a
physical split or
separation of the two
sides of the upper lip
and appears as a
narrow opening or
gap in the skin of the
upper lip. This
separation often
extends beyond the
base of the nose and
includes the bones of
the upper jaw and/or
upper gum.
 Cleft Palate - is a
split or opening in
the roof of the
mouth. A cleft
palate can involve
the hard palate
(the bony front
portion of the roof
of the mouth)
and/or the soft
palate (the soft
back portion of the
roof of the mouth).
Types of cleft lips
Unilateral: on one side
Bilateral: on both sides
Complete: extends all the way into the nostril
Incomplete: does not extend up into the nostril
Isolated: cleft lip without a cleft palate

Types of cleft palates (opening at the roof of the mouth)

Alveolar: a cleft in the upper gum line (alveolus) that may or may not
extend into the cleft palate
Submucous: a cleft in the soft palate near the back of the roof of the
mouth that is covered by a thin layer of skin or tissue; this type of cleft
is often hard to diagnose because it's not easily seen
Complete: extends from the front all the way to the back of the palate
Incomplete: does not extend all the way through the hard and soft
palates
Isolated: a cleft palate without a cleft lip
 Incidence
Cleft Lip is more prevalent among boys than
girls and occurs at a rate of approximately 1 in
every 700 live births.
Cleft palate it tends to occurs more frequently in
girls than boys.
Almost 30% of children with both cleft lip and
palate has associated birth defects
 Phatophysiology
Embryonic development lower lip and nose fuses
with 5 major facial prominences

Lip development:-3 and & 7th week

Palate Development: 5 & 12th week

Failure of fusion of the maxillary and premaxillary

process fusion

Complete or partial non-union may affect the

palatal bone, upper lip along with maxilla,
premaxilla and tissue of soft palate and uvula

Cleft lip and cleft

plate
 Risk factors Complications
Feeding problems
Family history of cleft lip or Loss of hearing
cleft palate Ear infections
Pregnant women who smoke, Dental problems
drink alcohol, or take some Speech problems
medications Tendency to be involved
Pregnant women who have with other medical
been diagnosed with diabetes conditions, such as social,
before the pregnancy emotional, and behavioral
Obesity during pregnancy problems.
What causes cleft lip and cleft palate?
In most cases, there’s no known cause of cleft lip or
cleft palate, and parents can’t prevent it. Most
scientists believe a combination of genetic
(inherited) and environmental (related to the
natural world) factors cause clefts. There seems to
be a greater chance of a newborn having a cleft if a
sibling, parent or other relative has one.
How to Prevent Cleft Lip and Cleft Palate?
Although oral clefts are typically not preventable, it
makes sense to take folic acid starting prior to
conception (at least 400 micrograms per day) and
try to avoid alcohol and smoking in pregnancy.
Achieving a healthy weight prior to pregnancy can
have numerous benefits..
 Clinical Manifestations
Symptoms of cleft lip and palate may include:
Crooked, poorly shaped or missing teeth
Misalignment of teeth and jaw
Deformities of the upper jaw (maxilla)
Speech problems
Unrepaired oronasal fistulae, which is a hole between the mouth and nose cavity
Alveolar clefts, which are defects in the bone that supports the teeth

Another kind of cleft palate called submucous cleft palate is unnoticeable at birth but as
its signs and symptoms develop. The signs and symptoms of submucous cleft palate may
include:

Feeding problems
Swallowing problems, such as liquids or food coming out from the nose
Voice of nasal speaking
Chronic infections in the ear
 Diagnostic Tests

Prenatal Ultrasound - Enables many cleft

lips and some cleft palates to be identified
in utero
MRI (Magnetic Resonance Imaging) - To
evaluate extent of abnormality before
treatment
X-ray - Shows deformity of palatine bone
 Assessment and Diagnostic Findings
The physical appearance of the newborn confirms the diagnosis of cleft lip;
diagnosis of cleft palate is made at birth.
Inspection. Diagnosis of cleft palate is made at birth with the close inspection
of the newborn’s palate; to be certain that a cleft palate is not missed, the
examiner must insert a gloved finger into the newborn’s mouth to feel the
palate to determine that it is intact.
Observation. Cleft lip can be diagnosed through observation of the physical
appearance of the newborn.
 Management & Treatments
Surgery-To correct cleft lip and palate, the doctor usually
considers the conditions of each baby to determine an appropriate
time for the surgery and the type of surgery. The kinds of surgery
for cleft lip and palate are as follows:
Cleft lip repair
Cleft palate repair
Ear tube surgery
Appearance reconstructive surgery
 Management and Treatments
Your doctor may recommend additional treatment for complications
caused by cleft lip and cleft palate. Examples include:
Feeding strategies, such as using a special bottle nipple or feeder
Speech therapy to correct difficulty with speaking
Orthodontic adjustments to the teeth and bite, such as having braces
Monitoring by a pediatric dentist for tooth development and oral health
from an early age
Monitoring and treatment for ear infections, which may include ear
tubes
Hearing aids or other assistive devices for a child with hearing loss
Therapy with a psychologist to help the child cope with the stress of
repeated medical procedures or other concerns
 Nursing Interventions
Maintain adequate nutrition. Breastfeeding may be successful because the breast tissue
may mold to close the gap; if the newborn cannot be breastfed, the mother’s breast milk
may be expressed and used instead of formula; a soft nipple with a cross-cut made to
promote easy flow of milk may work well.
Positioning. If the cleft lip is unilateral, the nipple should be aimed at the unaffected side;
the infant should be kept in an upright position during feeding.
Tools for feeding. Lamb’s nipples (extra long nipples) and special cleft palate nipples
molded to fit into the open palate area to close the gap may be used; one of the simplest and
most effective methods may be the use of an eyedropper or an Asepto syringe with a short
piece of rubber tubing on the tip (Breck feeder).
Promote family coping. Encourage the family to verbalize their feelings regarding the
defect and their disappointment; serve as a model for the family caregiver’s attitudes
toward the child.
Reduce family anxiety. Give the family information about cleft repairs; encourage them to
ask questions and reassure them that any question is valid.
Provide family teaching. Explain the usual routine of preoperative, intraoperative, and
post-operative care; written information is helpful, but be certain the parents understand
the information.
 References
https://www.medparkhospital.com/en-US/disease-and-
treatment/cleft-lip-and-c

https://nurseslabs.com/cleft-lip-cleft-palate/

https://my.clevelandclinic.org/health/diseases/10947-cleft-
lip-cleft-palate#diagnosis-and-tests

https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html
Thank you for Listening!