Procedures
Treatment involves surgery to repair the defect and therapies to improve any related conditions. Surgery to correct cleft lip and palate is based on your child's particular situation. Following the initial cleft repair, your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose.
Therapy
Electropalatography (EPG)—a computer-based technique for training correct oral articulation placements; EPG provides a visual feedback display of the tongue's contact with the hard palate during speech (Lee, Law, & Gibbon, 2009). See Kummer (2014b) for a description of various technologies used in speech therapy for cleft-type speech errors.
Self-care
Clefts can be isolated (cleft lip only or cleft palate only), or they can occur in combination. They can be unilateral or bilateral, and they can be complete or incomplete. Figure 1 contains images of the most common types of cleft affecting the palate, along with a labeled image of intact structures.
Nutrition
For children with cleft palate, ear tubes may be placed to reduce the risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery involves placing tiny bobbin-shaped tubes in the eardrum to create an opening to prevent fluid buildup. Surgery to reconstruct appearance.
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What is the treatment for cleft lip and palate?
What technologies are used in speech therapy for cleft palate?
What are the different types of cleft palate?
How are ear tubes used to treat cleft palate?
What is a NAM device for cleft palate?
Nasoalveolar Molding (NAM) is a nonsurgical method of reshaping the gums, lip and nose before cleft lip and palate surgery. The NAM appliance is a small removable device similar to an orthodontic retainer. It gradually applies pressure to decrease the severity of the cleft and improve the shape of the nose.
What treatments are available for cleft lip and palate?
A cleft is usually treated with surgery. Other treatments, such as speech therapy and dental care, may also be needed. Your child will be cared for by a specialist cleft team at an NHS cleft centre.
What is a common procedure for correction of cleft palate?
A cleft palate usually is repaired with surgery called palatoplasty (PAL-eh-tuh-plass-tee) when the baby is 10–12 months old. The goals of palatoplasty are to: Close the opening between the nose and mouth. Help create a palate that works well for speech.
What equipment would be appropriate to use for feeding an infant who has undergone cleft lip/palate repair?
Most babies born with a cleft lip (and no cleft palate) feed well without any special equipment. They usually can breastfeed or use a regular bottle-feeding system. The only change needed might be positioning the nipple so the baby can latch.
Which tool is used for Gastroduodenostomy?
The gastroduodenostomy was reconstructed using an endoscopic linear stapler (ECHELON 60; Ethicon Endo-Surgery, Cincinnati, OH, USA).
What is the most common technique used for unilateral cleft lip repair?
In 1957, Millard published his preliminary results using a novel method that he referred to as the rotation-advancement method[7]. Since that time, his technique has undergone numerous modifications but still remains the most commonly used technique for unilateral cleft lip repair[8].
What tool is used for Palatoplasty?
The double-angle needle holder was found to have been really useful for oral surgeries, especially palatoplasty.
What is a pharyngeal flap used for?
Pharyngeal flap surgery makes it easier for the muscles to stop the air from getting into the nose while speaking. A flap of muscle is taken from the back wall of the throat and is attached to the soft palate. It looks like a bridge, making the large space at the back of the throat into two smaller spaces.
What is Pharyngoplasty surgery?
Pharyngoplasty is an operation to change the shape and function of the soft palate and the area around it called the pharynx.
Which of the following is appropriate feeding technique for an infant with cleft palate?
Pumping breast milk and using specialty bottles are supported as a way of feeding a baby with a cleft palate. The Breastfeeding and Lactation Program at CHOP, or a local lactation consultant, may be of great benefit to you and your baby as you attempt to establish good feeding behaviors.
What is a Logan bar for cleft lip?
The Logan Bow is an external device comprising a curved bow-shaped metal bar, with spikes attached to its cross bars, and is widely used as part of a cleft lip management to maintain postoperative apposition and to avoid excessive strain after cheiloplasty for a cleft lip.
Which nursing intervention is essential in the care of an infant with cleft lip and palate?
Cleft lip deformities can occur unilaterally, bilaterally or rarely, in the midline....Desired Outcomes.Nursing InterventionsRationaleFeed the infant slowly and burp frequently.Burping frequently during a feeding will reduce spitting up and prevent excessive swallowing of air.7 more rows•Mar 22, 2022
How to repair a cleft palate?
Cleft palate repair. Various procedures may be used to close the separation and rebuild the roof of the mouth (hard and soft palate), depending on your child's situation. The surgeon makes incisions on both sides of the cleft and repositions the tissue and muscles. The repair is then stitched closed. Ear tube surgery.
What is the procedure for cleft palate?
Ear tube surgery. For children with cleft palate, ear tubes may be placed to reduce the risk of chronic ear fluid, which can lead to hearing loss. Ear tube surgery involves placing tiny bobbin-shaped tubes in the eardrum to create an opening to prevent fluid buildup. Surgery to reconstruct appearance.
How to close a lip separation?
To close the separation in the lip, the surgeon makes incisions on both sides of the cleft and creates flaps of tissue. The flaps are then stitched together, including the lip muscles. The repair should create a more normal lip appearance, structure and function.
What is the procedure to correct a cleft lip?
Surgery to correct cleft lip and palate is based on your child's particular situation. Following the initial cleft repair, your doctor may recommend follow-up surgeries to improve speech or improve the appearance of the lip and nose.
How does surgery help cleft lip?
Surgery to repair cleft lip creates a more normal lip appearance, structure and function. Surgery is done in a way to minimize the appearance of the scar. The scar will fade over time but will always be visible.
When is cleft lip surgery performed?
Surgeries typically are performed in this order: Cleft lip repair — within the first 3 to 6 months of age. Cleft palate repair — by the age of 12 months, or earlier if possible. Follow-up surgeries — between age 2 and late teen years. Cleft lip and palate surgery takes place in a hospital.
How can surgery improve your child's appearance?
Surgery to reconstruct appearance. Additional surgeries may be needed to improve the appearance of the mouth, lip and nose. Surgery can significantly improve your child's appearance, quality of life, and ability to eat, breathe and talk.
What is the importance of dental care for a cleft lip?
Dental care starts at a very young age for the cleft patient. Maintaining proper dental health early minimizes tooth loss and maximizes the amount of alveolar bone present at the time of bone grafting, resulting in smaller bone clefts and less bone graft needed.
What is a cleft in a feeding therapist?
The type of cleft is determined and classified as bilateral, unilateral, or horseshoe shaped and complete or incomplete. The feeding therapist then checks for the presence of all oral reflexes that should be present at birth including rooting, suck initiation, and transverse tongue reflex.
How old should a baby be to have a cleft lip?
Although not absolute, a general and easy rule for timing of cleft lip repair is a rule of 10s: at least 10 pounds and at least 10 weeks of age.
What is the severity of a cleft?
The severity of issues (e.g., weight status, severity of cleft, respiratory issues, ability to feed orally) assists with determining how quickly the infant needs to be seen by the surgeon or other specialists (e.g., gastrointestinal; ear, nose, and throat) or whether admission to the pediatric hospital is warranted.
Can infants bottle feed with a cleft?
Most infants are able to bottle feed with a specialty device regardless of the size, location, or type of cleft. In cases in which infants are unable to meet their caloric needs orally, the reason is usually separate from the cleft. These issues may be respiratory, gastrointestinal, or cardiac in etiology.
Can you tap a cleft lip before surgery?
If taping or a palatal device is employed prior to lip surgery, this intervention occurs early in the treatment plan. For lip taping, family members are given instructions and a demonstration in the clinic by the plastic surgeon and nurse practitioner on placing tape across the cleft under some tension.
What is cleft lip?
Introduction#N#Cleft lip and/or palate is one of the most common congenital anomalies affecting the craniofacial structures. 1,2 These anomalies are considered a relevant public health issue by the World Health Organization3 due to its effects on facial aesthetics, function and psychosocial challenges for the child as well as for the social and financial burden for the family. 1 The incidence of cleft lip and palate is not uniform and varies according to different ethnicities. The global average is approximately one in every 700 newborns. 1,4 Increased rates have been reported for Native American and Asian populations at 1 in 500 births. European-derived populations present intermediate prevalence rates at 1 in 1000 and the lowest rates were reported for African populations at 1 in 2500 births. 4,5
What is the orofacial cleft?
Orofacial clefts are a collection of conditions that includes: clefting of the upper lip, the maxillary alveolus (dental arch), and the hard or soft palate, in various combinations. The anatomic combinations include: Clefting of the lip and/or alveolus can occur either unilaterally (one-side) or bilaterally (both sides).
Is the palatal segment on the side of the cleft tilted medially?
Intraorally there will be separation of the palatal shelves to various degrees, and the palatal segment on the side of the cleft is often tilted medially and superiorly. There is also a direct communication between the oral and nasal cavities on the affected side of the palate.
What is cleft lip and palate?
Craniofacial conditions, including cleft lip and palate, are congenital structural anomalies caused by atypical embryological development. Craniofacial differences are a result of interruption in embryologic growth between the 4th and 10th week of the developing embryo or fetus (Peterson-Falzone, Hardin-Jones, & Karnell, 2010).
When is cleft lip repair performed?
Surgeries can include one or more of the following: Repair of cleft lip (usually performed within the first 6 months of life) Repair of cleft palate (usually by 12 months of age in a child with typical development) Repair of submucous cleft palate.
What are the structures of a cleft lip?
Clefts can be isolated (cleft lip only or cleft palate only), or they can occur in combination.
Why do I have a cleft lip?
However, most cases are thought to result from multifactorial inheritance —an interaction between the person's genes (genetic predisposition) and specific environmental factors (see, e.g., Beaty et al., 2011). Clefting can also be caused by chromosomal differences in individuals born with genetic syndromes.
How to tell if a cleft is SMCP?
There are three signs of an SMCP: (a) zona pellucida —a blue discoloration due to levator veli palatini muscle diastasis (i.e., separation in the midline); (b) a bifid uvula; and (c) a palpable bony notch at the edge of the hard palate.
Can cleft lip be unilateral?
Clefts can be isolated (cleft lip only or cleft palate only), or they can occur in combination. They can be unilateral or bilateral, and they can be complete or incomplete. Figure 1 contains images of the most common types of cleft affecting the palate, along with a labeled image of intact structures.
Can SMCP be seen during surgery?
Another type of SMCP, referred to as an occult (hidden) submucous cleft palate (OSMCP) has no visual oral manifestations and can be diagnosed only by direct observation during surgery or by magnetic resonance imaging (MRI).
What is the best treatment for a cleft palate?
Speech and language therapy. Repairing a cleft palate will significantly reduce the chance of speech problems, but in some cases, children with a repaired cleft palate still need speech therapy . A speech and language therapist (SLT) will assess of your child's speech several times as they get older.
How to treat cleft palate in children?
Hearing problems may improve after cleft palate repair and, if necessary, can be treated by inserting tiny plastic tubes called grommets into the eardrums. These allow the fluid to drain from the ear. Sometimes, hearing aids may be recommended.
How to care for a cleft lip?
Children with clefts will have a care plan tailored to meet their individual needs. A typical care plan timetable for cleft lip and palate is: 1 birth to 6 weeks – feeding assistance, support for parents, hearing tests and paediatric assessment 2 3 to 6 months – surgery to repair a cleft lip 3 6 to 12 months – surgery to repair a cleft palate 4 18 months – speech assessment 5 3 years – speech assessment 6 5 years – speech assessment 7 8 to 12 years – bone graft to repair a cleft in the gum area 8 12 to 15 years – orthodontic treatment and monitoring jaw growth
Why is breastfeeding difficult for babies with cleft palate?
Feeding help and advice. Many babies with a cleft palate have problems breastfeeding because of the gap in the roof of their mouth. They may struggle to form a seal with their mouth – so they may take in a lot of air and milk may come out of their nose.
How long does it take to repair a cleft lip?
The operation usually takes 1 to 2 hours. Most babies are in hospital for 1 to 2 days.
How is a cleft treated?
A cleft is usually treated with surgery. Other treatments, such as speech therapy and dental care, may also be needed. Your child will be cared for by a specialist cleft team at an NHS cleft centre.
How long does it take to repair a baby's palate?
Palate repair surgery is usually done when your baby is 6 to 12 months old. The gap in the roof of the mouth is closed and the muscles and the lining of the palate are rearranged. The wound is closed with dissolvable stitches. The operation usually takes about 2 hours and is done using a general anaesthetic.