CLEFT LIP AND CLEFT PALATE
A 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.
A 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).
Cleft lip and cleft palate can occur on one or both
sides of the mouth. Because the lip and the palate develop separately, it is
possible to have a cleft lip without a cleft palate, or both together.
SIGNS AND SYMPTOMS
A child may
have one or more birth defects.
A cleft lip may be small just a small notch in the
lip. It may also be a complete split in the lip that goes all the way to the
base of the nose.
A cleft palate can be on one or both sides of the
roof the mouth. It may go the full length of the palate. Other symptoms include:
1. Change
in nose shape (how much the shape change varies)
2. Poorly
aligned teeth
Problems that may be
present because of a cleft lip or cleft palate are:
1. Failure
to gain weight
2. Feeding
problems
3. Flow
of milk through nasal passages during feeding
4. Poor
growth
5. Repeated
ear infections
6. Speech
difficulties.
THE TREATMENT AND
NURSING MANAGEMENT
Surgery to close the
cleft lip is often done when the child is between 6 weeks and 9 months old.
Surgery may be needed later in life the problem has a big effect on the nose
area. A cleft palate is usually closed within in the first year of life , so
that the child’s speech develops normally. Sometimes, a prosthetic device is
temporarily used to close the palate, so the baby can feed and grow until surgery can be done. Continued follow-up may
be needed with speech therapists and orthodontists.
A cleft lip may require
one or two surgeries depending on the extent of the repair needed. The initial
surgery is usually performed by the time a baby is 3 months old.
Repair of a cleft
palate often requires multiple surgeries over the course of 18 years. The first
surgery to repair the palate usually occurs when the baby is between 6 and 12
months old. The initial surgery creates a functional palate, reduces the
chances that fluid will develop in the middle ears,and aids in the proper
development of the teeth and facial bones.
Children with a cleft
palate may also need a bone graft when they are about 8 years old to fill in
the upper gum line, so that it can support permanent teeth and stabilize the
upper jaw. Above 20% of children with a cleft palate require further surgeries
to help improve their speech.
Once the permanent
teeth grow in, braces are often needed to straighten the teeth.
Additional surgeries
may be performed to improve the appearance of the lip and nose,close openings
between the mouth and nose.help breathing, and stabilize and realign the jaw.
Final repairs of the scans left by the initial surgery will probably not be
performed until adolescence, when the facial structure is more fully developed.
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