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Cleft lip (cheiloschisis) and cleft palate(palatoschisis) (colloquially known asharelip), which can also occur together ascleft lip and palate, are variations of a typeof clefting congenital deformity caused byabnormal facial development during
gestation
A cleft is a fissure or openinga gap. It isthe non-fusion of the body's naturalstructures that form before birth
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Development of the face and palate http://www.indiana.edu/~anat550/hnanim/f
ace/face.html
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The palate structure of the mouth is notaffected
The clef is on top of the lip as either asmall gap or an indentation in the lip(partial or incomplete cleft) or it continuesinto the nose (complete cleft)
Lip cleft can occur as a one sided
(unilateral) or two sided (bilateral)
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Unilateral Incomplete Unilateral Complete Bilateral Complete
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A mild form of a cleft lip is amicroform cleft. It can appear as a little dent in the redpart of the lip or look like a scar fromthe lip up to the nostril
In some cases muscle tissue in the lipunderneath the scar is affected and
might require reconstructive surgery
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The two plates of the skull that form thehard palate (roof of the mouth) are notcompletely joined
The soft palate is in these cases cleft as
well. In most cases, cleft lip is also present
Can occur as complete (soft and hard
palate, possibly including a gap in thejaw) or incomplete (a 'hole' in the roof ofthe mouth, usually as a cleft soft palate
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When cleft palate occurs, the uvula isusually split.
The hole in the roof of the mouthcaused by a cleft connects the mouthdirectly to the nasal cavity
http://en.wikipedia.org/wiki/Palatine_uvulahttp://en.wikipedia.org/wiki/Nasal_cavityhttp://en.wikipedia.org/wiki/Nasal_cavityhttp://en.wikipedia.org/wiki/Palatine_uvula7/28/2019 Cleft Lip Palate[1]
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Incomplete cleft
palate
Unilateral complete
lip and palateBilateral complete lip
and palate
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A direct result of an open connectionbetween the oral cavity and nasal cavity
is velopharyngeal insufficiency (VPI). Because of the gap, air leaks into thenasal cavity resulting in a hypernasal
voice resonance and nasal emissions Secondary effects of VPI include speecharticulation errors (e.g., distortions,
substitutions, and omissions)
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Unknown
Medications
Smoking
Parental age Family history
Race
Gender
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Ear infections/ hearing loss.Children with cleft palate are at increased risk of
ear infections since they are more prone to fluidbuild-up in the middle ear.
If left untreated, ear infections can cause hearingloss.
To prevent this from happening, children with cleftpalate usually need special tubes placed in the
eardrums to aid fluid drainage, and their hearing
needs to be checked once a year
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Speech problemsChildren with cleft lip or cleft palate may also
have trouble speaking. These children's voicesdon't carry well, the voice may take on a nasal
sound, and the speech may be difficult to
understand. Not all children have these
problems and surgery may fix these problems
entirely for some
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Dental Problems Children with clefts are more prone to a larger than
average number of cavities and often have missing,extra, malformed, or displaced teeth requiringdental and orthodontic treatments.
In addition, they often have an alveolar ridge
defect. A defect in the alveolus can (1) displace,tip, or rotate permanent teeth, (2) preventpermanent teeth from appearing, and (3) preventthe alveolar ridge from forming. These problems
can usually be repaired through oral surgery.
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Breastfeeding is allowed. It will take extratime and patience
The infant is held in an upright position tohelp keep the food from coming out of thenose
Small, frequent feedings are recommended
In some cases, supplements may be added to
breast milk or formula to help infant meethis/her calorie needs
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NUK nipple; The hole can be made larger by making acriss-cross cut in the middle.Mead Johnson Nurser;This is a soft, plastic bottle thatis easy to squeeze and has a large crosscut nipple.You may use any nipple that the infant prefers withthis system.
Haberman Feeder;This is a specially designed bottlesystem with a valve to help control the air the babydrinks and to prevent milk from going back into thebottle.
Syringes;These may be used in hospitals following cleftsurgery and may also be used at home. Typically, asoft, rubber tube is attached on the end of thesyringe, which is then placed in the infant's mouth.
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Feeding baby with clef palate http://www.cleftline.org/parents/feeding_you
r_baby
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Multidisciplinary approach
plastic/craniofacial surgeon -. Pediatrician
Orthodontist
Speech and language specialist
Otolaryngologist
audiologist
genetic counselor
nursing team social worker
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Infants with cleft lip alone, can be
repaired within the first severalmonths of life (usually when the babyis 10 to 12 pounds).
Repair of a cleft palate often requiresmultiple surgeries
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Additional surgeries may be performed toimprove the appearance of the lip and nose,
close openings between the mouth and nose,help breathing, and stabilize and realign the
jaw.
Final repairs of the scars left by the initialsurgery will probably not be performed untiladolescence, when the facial structure ismore fully developed.
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child may be irritable following surgery
child may also have to wear padded restraintson his/her elbows to prevent him/her fromrubbing at the stitches and surgery site.
Stitches will either dissolve on their own orwill be removed in approximately five toseven day
In some cases, packing will be placed on the
palate
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For a day or two, child will feel mild pain
It is normal to have swelling, bruising, and bloodaround these stitches
There may be some bloody drainage coming fromthe nose and mouth that will lessen over the firstday.
child will have an intravenous catheter (IV) toprovide fluids until he/she is able to drink bymouth
Many infants show signs of nasal congestion after
surgery. These signs may include nasal snorting,mouth breathing, and decreased appetite.
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child will be on antibiotics
small amount of water should be offered after
every bottle or meal to cleanse the incision.
Continual to rinsing of this area gently with
water several times a day, if necessary.
child can walk or play calmly after surgery.He/she should not run or engage in rough p
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Altered comfort pain
Altered nutrition Risk for compromised family coping related
to stress of surgery
Risk for injuries or difficulities with airwaymanagement
Risk for infection
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