Cleft lip/palate

Question 1

most common craniofacial malformation

-may occur in isolation or combination

Answer 1

cleft lip/palate

Question 2

cleft lip with or without cleft palate is more common in ___-

Answer 2

males

Question 3

cleft palate alone is more common in ___

Answer 3

females

Question 4

etiology of cleft lip/palate

Answer 4

• genetics (familiaI)
• associated defects with other chromosomal abnormalities
• teratogens (mom may not know she is pregnant; so hard to look at causes)

Question 5

cleft lip is a failure of the _______ and _______ to fuse

Answer 5

maxillary and median nasal processes to fuse

Question 6

the merging of the upper lip at midline is complete by _______ gestation

Answer 6

7-8 weeks

(tongue has to get out of the way in order for the palates to fuse

Question 7

cleft palate appears when there is a failure of the _____ to fuse

Answer 7

palatal shelves

Question 8

what meds can help prevent cleft palate during pregnancy>

Answer 8

folic acid

Question 9

feeding techniques to those with cleft palate/lip

Answer 9

1. breast feeding:
   - the breast will conform better to odd shape of lips
2. special gadgets
   - orthodontist may make an obturator
   - feeding with flanged nipple
   - lambs nipple
   - syringe- brecht feeder allows to help drop the formula into the mouth
   - can put back further into mouth
   - prevent swallowing of lots of air

Question 10

cleft lip surgical correction

Answer 10

Z-plasty

-usually done at 6-12 weeks of age in healthy infant

Question 11

cleft palate surgical correction

Answer 11

Palatoplasty

• usually done bw 12-18 months
• repaired before development of speech
• much harder to repair than lip (nothing extra to work with, so as they grow, the cleft in the palate will get smaller)
• harder to repair if wait too long

Question 12

Preop nursing interventions for cleft lip/palate

Answer 12

• family coping related to defect
• feeding techniques
• preparation for surgery (consent, expectations)
• prevention of complications

Question 13

post-op care for cleft lip

Answer 13

Goal: protection of surgical site

NEVER position on stomach
-put on side or back lying position or in infant seat

Elbow restraints
-prevent injury to surgical site

Oral and wound care
-prevent scar tissue from building up

Comfort measures/pain control

Logan’s bar or steri-strips

• to hold and protect suture line
• clean suture line carefully with solution of saline if ordered
• apply neosporin if ordered

Question 14

post- op complications for cleft lip

Answer 14

• bleeding
• infant upset
• nose breathers, so will not be able to breathe through nose (inflammation)

Question 15

cleft palate post-op

Answer 15

• elbow restraints
• issues with airway, because of where suture line is (observe breathing pattern and intervene as needed)
• frequent swallowing, sign of bleeding
• no sucking pacifiers or straws
• avoidance of utensils til healed

Question 16

cleft palate post-op (continued)

Answer 16

• progress diet to blenderized food with progression to soft diet
• use cup for drinking
• comfort measures/pain
• control complications

Question 17

cleft palate post-op complications

Answer 17

• middle ear infections
• nasopharyngeal infections
• sinus infections
• associated hearing loss
• speech delay

Question 18

psychosocial issues for parents with kids with cleft lip/palate

Answer 18

• may have trouble bonding with child
• grief
• realize the child is not perfect
• financial support
• teach physical care of infant
• routine health maintenance
• seek medical care early in illness
• concern over speech