Cleft disorders

Question 1

Cleft palate

Answer 1

Congenital abnormality

Midline tissue of two sides fails to fuse during embryotic development

Question 2

Cleft lip

Answer 2

Congenital abnormality

Failure of maxillary and median nasal processes to fuse during embryotic development

Question 3

Causes-

Answer 3

Can be unknown; idiopathic
Hereditary, genetics
Environmental factors such as radiation, ETOH, smoking
Medications such as phenytoin, Accutane

Question 4

Incidences

Answer 4

Male > female
more common Asians, American Indians
50% are cleft lip/palate combo

Question 5

Complications with clefts

Answer 5

Breathing
Feeding difficulties
ear infections/hearing loss
speech/language delays
dental problems

Question 6

Breathing complications

Answer 6

Reduced size of nasal airway, often causing mouth breathing; will be tired easily- can lead to inadequate nutrition.

Question 7

Feeding difficulties

Answer 7

Difficulty breathing through nose

Will need large size nipple bottles, allow faster flow, wont need sucking effect

Question 8

Ear infections/hearing loss

Answer 8

D/T abnormal position of muscles and tendons, causing Eustachian tube to not drain properly, leading to fluid remaining in ear canal, can lead to Otis media
Chronic Otis media leads to perforation of tympanic membrane

Question 9

Speech language delays

Answer 9

Leads to nasally speech

D/T palate not closing off the mouth and nose letting air escape through the nose

Question 10

Dental problems

Answer 10

Possibly d/t smaller mouth/jaw, poor bone support

Question 11

Surgical repair cleft lip

Answer 11

Done prior to cleft palate, usually around 10-12 weeks

Must be free of any oral, respiratory or systemic infection

Question 12

Surgical repair cleft palate

Answer 12

Usually done around 6- 18 months, allowing palate changes to take place

Question 13

Possible prognosis after repair

Answer 13

speech, physical impairment, drainage of middle ear, URI’s, social adjustment

Question 14

Post op care

Answer 14

NPO
Place on back or side
Logan bow/steri strips tapped to face to maintain & keep sutures intact
Care is geared towards not disturbing suture line
- do not suction, use straws, pacifiers
-no breast feeding
-May need restraints Q 2-3 weeks (only if necessary)
-Special nipple- breck feeder/haberman feeder

Question 15

CLEFT LIP

Answer 15

C-Choking, prevent
L-lie on back
E- evaluate airway
F- feed slowly
T- Teaching (parents) 

L- large nipple
I- increased incidence in males
P- prevent crust formation, aspiration