Cleft lip (cheiloschisis) and cleft palate (palatoschisis) (colloquially known as harelip), which can also occur together

as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation A cleft is a fissure or openinga gap. It is the non-fusion of the body's natural structures that form before birth

Development of the face and palate http://www.indiana.edu/~anat550/hnanim/f ace/face.html

The palate structure of the mouth is not affected The clef is on top of the lip as either a small gap or an indentation in the lip (partial or incomplete cleft) or it continues into the nose (complete cleft) Lip cleft can occur as a one sided (unilateral) or two sided (bilateral)

Unilateral Incomplete

Unilateral Complete Bilateral Complete

mild form of a cleft lip is a microform cleft. It can appear as a little dent in the red part of the lip or look like a scar from the lip up to the nostril In some cases muscle tissue in the lip underneath the scar is affected and might require reconstructive surgery

The two plates of the skull that form the hard palate (roof of the mouth) are not completely 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 the jaw) or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate

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cleft palate occurs, the uvula is usually split. hole in the roof of the mouth caused by a cleft connects the mouth directly to the nasal cavity

The

Incomplete cleft palate

Unilateral complete Bilateral complete lip lip and palate and palate

A direct result of an open connection between the oral cavity and nasal cavity is velopharyngeal insufficiency (VPI). Because of the gap, air leaks into the nasal cavity resulting in a hypernasal voice resonance and nasal emissions Secondary effects of VPI include speech articulation errors (e.g., distortions, substitutions, and omissions)

Unknown Medications Smoking Parental age Family history Race Gender

Eating problems Feeding difficulties occur more with cleft palate abnormalities. The infant may be unable to suck properly because the roof of the mouth is not formed completely. With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose. Fortunately, there are specially designed baby bottles and nipples that help keep fluids flowing downward toward the stomach are available.

Ear infections/ hearing loss. Children with cleft palate are at increased risk of ear infections since they are more prone to fluid build-up in the middle ear. If left untreated, ear infections can cause hearing loss. To prevent this from happening, children with cleft palate usually need special tubes placed in the eardrums to aid fluid drainage, and their hearing needs to be checked once a year

Speech problems Children with cleft lip or cleft palate may also have trouble speaking. These children's voices don'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

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 requiring dental 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) prevent permanent teeth from appearing, and (3) prevent the alveolar ridge from forming. These problems can usually be repaired through oral surgery.

Breastfeeding is allowed. It will take extra time and patience The infant is held in an upright position to help keep the food from coming out of the nose Small, frequent feedings are recommended In some cases, supplements may be added to breast milk or formula to help infant meet his/her calorie needs

NUK nipple; The hole can be made larger by making a criss-cross cut in the middle. Mead Johnson Nurser;This is a soft, plastic bottle that is easy to squeeze and has a large crosscut nipple. You may use any nipple that the infant prefers with this system. Haberman Feeder;This is a specially designed bottle system with a valve to help control the air the baby drinks and to prevent milk from going back into the bottle. Syringes;These may be used in hospitals following cleft surgery and may also be used at home. Typically, a soft, rubber tube is attached on the end of the syringe, which is then placed in the infant's mouth.

Feeding baby with clef palate http://www.cleftline.org/parents/feeding_you r_baby

Multidisciplinary approach plastic/craniofacial surgeon -. Pediatrician Orthodontist Speech and language specialist Otolaryngologist audiologist genetic counselor nursing team social worker

 Infants

with cleft lip alone, can be repaired within the first several months of life (usually when the baby is 10 to 12 pounds). Repair of a cleft palate often requires multiple surgeries

The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones. Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw Once the permanent teeth grow in, braces are often needed to straighten the teeth

Additional surgeries may be performed to improve 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 initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.

child may be irritable following surgery child may also have to wear padded restraints on his/her elbows to prevent him/her from rubbing at the stitches and surgery site. Stitches will either dissolve on their own or will be removed in approximately five to seven day In some cases, packing will be placed on the palate

For a day or two, child will feel mild pain It is normal to have swelling, bruising, and blood around these stitches There may be some bloody drainage coming from the nose and mouth that will lessen over the first day. child will have an intravenous catheter (IV) to provide fluids until he/she is able to drink by mouth Many infants show signs of nasal congestion after surgery. These signs may include nasal snorting, mouth breathing, and decreased appetite.

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

Altered comfort pain Altered nutrition Risk for compromised family coping related to stress of surgery Risk for injuries or difficulities with airway management Risk for infection