Although a cleft lip and a cleft palate often appear together, either defect may appear alone.
- Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both.
- Cleft lip and cleft palate are among the most common birth defects. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndromes.
In embryonic development, the palate closes later than the lip, and the failure to close occurs for different reasons.
- Normally the palate is intact by the 10th week of fetal life.
- The cleft lip and palate defects result from failure of the maxillary and premaxillary processes to fuse during the 5th to 8th week of intrauterine life.
- The child born with a cleft palate but with an intact lip does not have the external disfigurement that may be so distressing to the new parent; however, the problems are more serious.
- The cleft may be a simple notch in the vermilion line, or it may extend up into the floor of the nose.
- Exactly what happens to prevent this closure is not known for sure, leading to a cleft lip and cleft palate.
- In an 8-week old embryo, there is still no roof to the mouth; the tissues that are to become the palate are two shelves running from the front to the back of the mouth and projecting vertically downward on either side of the tongue.
Symptoms — Usually, a split (cleft) in the lip or palate is immediately identifiable at birth. Cleft lip and cleft palate may appear as:-
- A split in the lip that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose.
- A split in the lip and roof of the mouth (palate) that affects one or both sides of the face.
- A split in the roof of the mouth that doesn’t affect the appearance of the face.
Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth’s lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop. Signs and symptoms of submucous cleft palate may include:-
-Nasal speaking voice.
-Difficulty with feedings.
-Chronic ear infections.
-Difficulty swallowing, with potential for liquids or foods to come out the nose.
Cleft lip and cleft palate occur when tissues in the baby’s face and mouth don’t fuse properly. Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only part way, leaving an opening (cleft).
Researchers believe that most cases of cleft lip and cleft palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn’t discovered.
The mother or the father can pass on genes that cause clefting, either alone or as part of a genetic syndrome that includes a cleft lip or cleft palate as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.
Risk factors —
Several factors may increase the likelihood of a baby developing a cleft lip and cleft palate, including:-
Being obese during pregnancy.
Exposure to certain substances during pregnancy.
Complications — Children with cleft lip with or without cleft palate face a variety of challenges, depending on the type and severity of the cleft,
– Ear infections and hearing loss,
– Speech difficulties,
– Challenges of coping with a medical condition,
– Dental problems,
– Difficulty feeding,
Assessment and Diagnostic Findings –
The physical appearance of the newborn confirms the diagnosis of cleft lip; diagnosis of cleft palate is made at birth.
* Observation – Cleft lip can be diagnosed through observation of the physical appearance of the newborn.
*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.
Medical Management –
Treatment for a newborn with cleft lip and palate includes:-
Surgery – Cleft lip repair, usually performed by a plastic surgeon, is a major part of the treatment of a newborn with cleft lip, palate, or both; some surgeons favor early repair, before the newborn is discharged from the hospital; other surgeons prefer to wait until the newborn is 1 to 2 months old, weighs about 10 lbs, and is gaining weight steadily.
Dental speech appliance – If surgery must be delayed beyond the 3rd year, a dental speech appliance may help aid the child develop intelligible speech.
A complete and thorough process of care should be undergone by the newborn with cleft lip and cleft palate.
One primary concern in the nursing care of the newborn with a cleft lip and cleft palate is the emotional care of the newborn’s family.
Physical exam — Physical examination of the infant includes temperature, apical pulse, and respirations; listen to breath sounds, observe skin turgor and color, infant’s neurologic status, noting alertness and responsiveness.
Interview — In interviewing the family and collecting data, the nurse must include exploration of the family’s acceptance of the newborn; conduct a thorough interview with the caregiver that includes a question about the methods they found to be most effective in feeding the infant.
Major goals for the care of the infant with cleft lip and cleft palate include:-
- Maintained adequate nutrition.
- Increased family coping.
- Reduced parents’ anxiety and guilt regarding the newborn’s physical defects.
After a baby is born with a cleft, parents are understandably concerned about the possibility of having another child with the same condition. While many cases of cleft lip and cleft palate can’t be prevented, consider these steps to increase your understanding or lower your risk:-
- Consider genetic counseling,
- Don’t use tobacco or alcohol,
- Take prenatal vitamins,