CLEFT LIP AND PALATE

A Case Study Presented to the Faculty of College of Health Sciences Education In

Partial Fulfillment of the Requirements in NCM 121N/L

Code: 9071

Submitted by:

Sheila Mae C. Saclot BSN-4

Submitted to:

Majella Gonzales, RN, MAN

February 2022
DEFINITION

Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not
form properly during pregnancy. Together, these birth defects commonly are called
“orofacial clefts”. 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 result when facial structures that are
developing in an unborn baby don't close completely. 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.

SIGNS AND 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 and roof of the mouth (palate) that affects one or both sides of the
face
✓ 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 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:
✓ Difficulty with feedings
✓ Difficulty swallowing, with potential for liquids or foods to come out the nose
✓ Nasal speaking voice
✓ Chronic ear infections

ETIOLOGY (RISK FACTOR)

▪ Several factors may increase the likelihood of a baby developing a cleft lip and cleft
palate, including:
▪ Family history. Parents with a family history of cleft lip or cleft palate face a higher
risk of having a baby with a cleft.
 ▪ Exposure to certain substances during pregnancy. Cleft lip and cleft palate may be
more likely to occur in pregnant women who smoke cigarettes, drink alcohol or take
certain medications.
▪ Having diabetes. There is some evidence that women diagnosed with diabetes before
pregnancy may have an increased risk of having a baby with a cleft lip with or
without a cleft palate.
▪ Being obese during pregnancy. There is some evidence that babies born to obese
women may have increased risk of cleft lip and palate.

MEDICAL MANAGEMENT
Treatment for a newborn with cleft lip and palate includes:
Surgery
1. 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.
2. Dental speech appliance. If surgery must be delayed beyond the 3rd year, a dental
speech appliance may help aid the child develop intelligible speech.
3. Cleft lip repair (Cheiloplasty) - 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, including the lip muscles. The repair should create a more normal
lip appearance, structure and function.
4. Cleft palate repair (palatoplasty)- Various procedures may be used to close the
separation and rebuild the roof of the mouth (hard and soft palate), depending on your
child's situation. The surgeon makes incisions on both sides of the cleft and
repositions the tissue and muscles.
5. Ear tube surgery- For children with cleft palate, ear tubes may be placed to reduce the
risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery involves
placing tiny bobbin shaped tubes in the eardrum to create an opening to prevent fluid
build-up.
NURSING MANAGEMENT
Preoperative Care
▪ Keep the infant NPO for 6 hours before surgery.
▪ Administer premedication as per doctors order.
▪ Physical, physiological, psychological and legal preparation should be done.
Post-operative Care
▪ Keep the airway clear from accumulation of mucus in the nose and mouth.
▪ Mild sedation may be prescribed to prevent infant from crying.
▪ Careful positioning (never on the abdomen).
▪ Restraining the arms if necessary.
▪ Clear fluids offers initially, breast milk or formula can be given when tolerated.
▪ The mouth should be rinsed with water before and after feeding.
▪ Do not brush the teeth 1- 2 weeks after the surgery.
▪ The suture line must be cleaned gently with cotton or gauze-tipped swab dipped in
hydrogen peroxide or saline solution and dried carefully several times a day to ensure
proper healing.
 NURSING
ASESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Objective Cues: Imbalanced Nutrition: That within my 3 days 1. Establish rapport. 1. To facilitate cooperation Goal Met
Less Than Body span of care, the and to gain client’s trust.
• Anatomical Requirements related to infant will be able to 2. Assess infant sucking and 2. The infant with a cleft - The infant exhibited
malformation of inability to ingest food exhibit adequate swallowing ability. lip or palate may find it adequate nutritional
the lip and as evidenced by nutritional status as challenging to establish status by gaining
palate. presence of cleft lip and evidence by gaining breast and bottle feeding due weight steadily.
• Difficulty in palate. weight steadily. to the impaired sucking
swallowing. ability hence compromising
nutrition.
3. Monitor daily fluid and 3. Provides an objective
calorie intake. measurement of whether the
infant is receiving sufficient
caloric intake to promote
growth.
4. Assess weight daily. 4. Using the same scale
and procedure when
Reference: weighing the infant provides
Vera, M. (2019). for comparability between
Cataract Nursing Care daily weights.
Plan. Nurse’s pocket 5. Observe for any 5. Any symptoms of
guide: diagnoses, respiratory impairment. Respiratory compromise will
prioritized interventions, interfere with the infant’s
and rationales. ability to suck. Feeding
Washington DC: Sage should be initiated only if
Publications. there are no signs of
respiratory distress.
6. Instruct the mother to 6. Large nipples are
used large in feeding. available to help infants feed
and grow and can properly
suck adequate amount of
milk for nutrition.
7. Hold the infant in a 7. Makes swallowing easier
semi-sitting position.
8. Instruct mother who
bottle feed to use some
cereal to thicken the milk.
9. Encourage frequent
burping after feeding.
10. Initiate NGT as
Ordered.
and reduces the amount of
fluid return from the nose.
8. Thicker milk will make
swallowing easier due to the
increased gravity flow
brought about it.
9. When an infant drink from
a bottle, they can swallow
some air, which goes down
into their stomach along with
the milk or formula so
burping will help to prevent
it from happening.
10. If the infant is unable to
ingest sufficient calories by
mouth.
HEALTH TEACHINGS
✓ Show proper feeding techniques and positions.
✓ Explain the usual routine of preoperative, intraoperative, and post-operative care; written
information is helpful, but be certain the parents understand the information.
✓ Give the family information about cleft repairs; encourage them to ask questions and
reassure them that any question is valid.
✓ Discuss the need for, at least, annual hearing evaluations because of the increased
susceptibility to recurrent otitis. The child may require myringotomy and surgical placement
of drainage tubes.
✓ Teach infection control measures.
REFERENCES

Frisbee, E. (2021). Cleft Lip and Cleft Palate. Retrieved from https://www.webmd.com/oral-
health/cleft-lip-cleft-palate.

Mayo Clinic. (2022). Cleft lip and cleft palate. Retrieved from
https://www.mayoclinic.org/diseases-conditions/cleft-palate/symptoms-causes/syc-
20370985.

University of Rochester Medical Center. (2020). Cleft Lip/Cleft Palate. Retrieved from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid
=P01847.

Vera, M. (2019). Cataract Nursing Care Plan. Nurse’s pocket guide: diagnoses, prioritized
interventions, and rationales. Washington DC: Sage Publications.