Cleft lip-Cleft Palate

Cleft lip and palate are birth defects that actually happen when a baby's lip or mouth do not develop properly during pregnancy. These birth defects are usually referred to as "orofacial clefts."

Cleft lip: Between the fourth and seventh weeks of pregnancy, the lip develops. Body tissue and special cells from each side of the head grow toward the center of the face and join together to form the face as a baby develops during pregnancy. This fusion of tissue results in the formation of facial features such as the lips and mouth. A cleft lip occurs when the tissue that makes up the lip does not completely join before birth. As a result, an opening appears in the upper lip. The lip opening can be a small slit or a large opening that extends through the lip and into the nose. A cleft lip can occur on one or both sides of the lip, or it can occur in the middle of the lip, which is extremely rare. Children who have a cleft lip may also have a cleft palate.

Cleft palate: Between the sixth and ninth weeks of pregnancy, the palate (the roof of the mouth) develops. A cleft palate occurs when the tissue that makes up the roof of the mouth does not completely fuse together during pregnancy. Both the front and back parts of the palate are open in some babies. Only a portion of the palate is open in other babies.

Causes:

Most infants' orofacial clefts are caused by unknown factors. Some children have cleft lip or cleft palate due to genetic changes. Cleft lip and palate are thought to be caused by a combination of genes and environmental factors, such as what the mother comes into contact with in her environment, what she eats or drinks, and certain medications she uses during pregnancy.

Risk factors:

• Smoking: Women who smoke during their pregnancy are more likely than women who do not smoke to have a baby with an orofacial cleft.
• Diabetes: Women who have diabetes before pregnancy have a higher risk of having a child with cleft lip and palate, compared to women who do not have diabetes.
• Use of certain medicine: Women who took certain epilepsy medications, such as topiramate or valproic acid, during the first trimester (the first three months) of pregnancy have an increased risk of having a baby with cleft lip and/or cleft palate, compared to women who did not take these medications.

Signs and symptoms:

A split (cleft) in the lip or palate is usually noticeable at birth. Cleft lip and palate can express as:

• A split in the lip and roof of the mouth (palate) can occur on one or both sides of the face.
• A split in the lip that can be as small as a notch or can extend from the lip through the upper gum and palate into the bottom of the nose.
• A split in the roof of the mouth that has no effect on the face's appearance.

A cleft occurs less frequently in the muscles of the soft palate (sub-mucous cleft palate), which are located at the back of the mouth and are covered by the mouth's lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until symptoms appear later. Submucous cleft palate signs and symptoms may include:

• Feeding difficulties
• Difficulty swallowing, with the possibility of liquids or foods coming out the nose
• Voice of Nasal Speaking
• Ear infections that are chronic

Diagnosis:

• A routine ultrasound can detect orofacial clefts, particularly cleft lips with or without cleft palate, during pregnancy.
• Certain types of cleft palate, such as the submucous cleft palate and bifid uvula, may not be diagnosed until later in life.

Treatment:

• When a child is about 3-6 months old, he or she can have a cleft lip repaired.
• Unilateral cleft lip repair can take 3-6 weeks.
• A 4.5kg infant with a hemoglobin of 11.8 gm/dl and no respiratory infection is a candidate for surgery.
• Cleft palate surgery is usually performed before the child learns to speak.

Nursing management of cleft lip and cleft palate:

• By displaying another baby with the same condition, the mother can be reassured and relieved of her distress.
• Feeding should be done slowly and in an upright position. Sucking breast is not hampered by a cleft lift lip in the absence of a cleft palate. In severe cases of cleft lip and palate, a nipple must be spoon-fed from birth. To maintain lactation, breast milk should be expressed while breastfeeding.
• Cleft palates tend to swallow a lot of air while feeding, so wind must be brought in.
• After feeding, rinse the mouth with water.