Cleft lip and cleft palate ppt

PEDIATRIC NURSING

1. CLEFT LIP AND CLEFT PALATE P.THIRUNAGLINGA PANDIYAN M.Sc .,(N)., M.A., D.Pharm ., School of Nursing Madurai Medical College Madurai

2. INTRODUCTION The dictionary meaning of Cleft is a Crack, Fissure, Split or Gap. Cleft lip and palate is a congenital birth defect which is characterized by complete or partial cleft of lip and/or palate Not life threatening unless associated with other syndrome

3. CLEFT LIP A cleft lip is an opening or split in the upper lip that occurs when developing facial structures in an unborn baby don't close completely. Cleft lip may be unilateral or bilateral . A cleft lip can be on one or both sides of the lip or in the middle of the lip More often in boys than girls

4. Anatomy of lip

5. CLEFT PALATE A cleft palate is an opening or split in the roof of the mouth that occurs when the tissue doesn't fuse together during development in the uterus .

6. Anatomy of palate

7. EMBRYOLOGY – DEVELOPMENT OF LIP AND PALATE Mandibular arch plays a role in development of naso maxillary complex During 4- 5 th week of gestation Mandibular arch gives rise to form maxillary process With the formation of nasal pits, frontonasal process gets divided into a medial nasal process and two lateral nasal processes.

8. EMBRYOLOGY – DEVELOPMENT OF LIP AND PALATE Maxillary process fuse with medial and lateral nasal processes to form Upper Lip Lower Lip is formed by the fusion of Mandibular process of two sides. Failure of merging between the medial nasal and maxillary processes at 5 weeks’ gestation, on one or both sides results in Cleft Lip

9. EMBRYOLOGY – DEVELOPMENT OF LIP AND PALATE Development of Palate begins in 6th week Primary Palate develops from Medial Nasal Process Secondary Palate develops from Maxillary Process Fusion of Palatal Shelves begin at 8th week which continues till 12 th week.

10. EMBRYOLOGY – DEVELOPMENT OF LIP AND PALATE Initially the Palatal shelves are covered by an epithelial lining. The connective tissue of the Palatal shelves intermingle with each other resulting in fusion of Primary and Secondary palate Defective growth of Palatal shelves and Lack of fusion of primary and secondary palate causes cleft palate

11. causes Prenatal infection Drugs during antenatal period Poor nutrition during antennal period Advanced maternal age Radiation exposure

12. Types of cleft lip Unilateral - One side split of lip Bilateral cleft lip – Split of lip on both sides

13. Types of cleft palate

14. SIGNS AND SYMPTOMS OF CLEFT LIP AND CLEFT PALATE Difficulty with feedings Difficulty swallowing, with potential for liquids or foods to come out the nose Nasal speaking voice Chronic ear infections

15. Treatment SURGERY Surgery to correct Cleft Lip and Palate is based on the child's particular situation. Following the initial cleft repair and follow-up surgeries to improve speech or improve the appearance of the lip and nose. Surgeries typically are performed in this order: Cleft Lip Repair — Within the first 12 months of age Cleft Palate Repair — By the age of 18 months

16. Treatment CHEILOPLASTY Cleft Lip Repair.  To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together. The repair should create a more normal lip appearance, structure and function

17. Treatment PALATOPLASTY Cleft Palate Repair   Procedures used to close the separation and rebuild the roof of the mouth (hard and soft palate). The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed.

18. NURSING MANAGEMENT Pre Operative Care Prepare the child for surgical repair Explain the impact of defect Assist the mother with breast feeding

19. NURSING MANAGEMENT Pre Operative Care Stimulate let down reflex manually or by breast pump Modify feeding technique to be followed Use specific feeding appliances Hold the child in upright position to prevent aspiration

20. NURSING MANAGEMENT Post Operative Care Assess the vital signs Position to allow the drainage of mucous Maintain the lip protective devices ( Logan’s bow) Use non traumatic feeding

21. NURSING MANAGEMENT Post Operative Care Restrain the elbow Prevent vigorous crying Non vigorous sucking Teach the parents regarding cleaning and restraining Monitor IV fluids

22. NURSING MANAGEMENT NURSING DIAGNOSES 1. Imbalance nutrition less than body requirements 2. Ineffective airway clearance related to tracheobronchial aspirations of feeding 3. Anxiety related to congenital defect 4. Knowledge deficit of care taker 5. Risk for injury related to internal physical factor

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