Health alterations class 3-Cleft lip and palate

Part 1- CL and CP

Cleft lip

Failure of the maxillary and median nasal processes to fuse

Cleft palate

1. Mid line fissure of the palate that results from failure of the 2 sides to fuse

2. Can be isolated or associated with a cleft lip

2 of the most common birth defects in Canada

Cleft lip and cleft palate

Group with a higher incidence of cleft lip and cleft palate

Indigenous groups

Some causes of CP and CL

1. May be an isolated anomaly or occur with a recognized syndrome

2. Exposure to teratogens (alcohol, anticonvulsants, steroids, folic acid deficiency etc)

3. Genetic and environment factors (maternal infection, meds such as antiepileptic meds)

4. Maternal obesity

5. Smoking

CL and CP Pathophysiology

Genetic defect in cell migration that results in the maxillary and pre maxillary processes not coming together properly between 3-12 weeks of gestation

When is the merging of the upper lip at the midline complete

Between 7-11 weeks of gestation

When is fusion of the secondary (hard and soft palate) complete

Between 7-12 weeks of gestation

CL and CP diagnostic evaluation

Prenatal ultrasound (usually 18 week ultrasound)

Common issues associated with CP and CL

1. Recurrent ear infections

2. Feeding problems (issues latching, drawing out milk, keeping milk in mouth etc)

3. Nasal regurgitation during bottle feeding

4. Growth retardation

5. Misaligned teeth

6. Poor speech

CL and CP pre-op care

1. Main issue is feeding (OT does assessment)

2. Blood work (CBC with differential, electrolytes, blood type etc)

What can help babies with CP or CL feed better?

1. Feed sitting up (gravity helps)

2. Special bottles

3. Sometimes moms breast can mold into CL

CP and CL post op care priority

Protecting the scar

How can a CL scar be protected post op

1. Elbow restraints (remove q4h)

2. Don’t let baby roll on belly (may rub their face)

3. Hold baby to avoid crying

How can a CP scar be protected post op

1. Soft, puréed foods

2. No utensils, straws etc

3. No red food

Signs a suture has opened up

Clearing throat, swallowing, gagging etc

Long term care of CP and CL

May have dental or speech issues

When is surgery for a CL usually done

At 10 weeks of age or 4.5 kg, usually before 3 months

CL scar prevention teaching

1. Scar massage

2. Petroleum jelly

3. Signs of infection

4. How to avoid breaking sutures

5. If mild may be able to use bottle or breast

When is a cleft palate surgery usually done

6-12 months of age (before 18 months)

Why is cleft palate usually fixed before 18 months of age

Because it can effect speech development and quality

How is pain managed after CP or CL surgery

1. First 24-48 hour: Opioids (regular, not PRN)

2. Tylenol after

Why might babies and toddlers be at an increased risk of infection

They breathe through their mouth

Comsiderations with a CL or CP scar

1. Caution in the sun (burns easier)

2. Facial hair may not grow or suture line