Cleft Lip Edited New Format

8/14/2019 Cleft Lip Edited New Format

1/55

Cleft Lip And PalateCleft Lip And Palate

ManagementManagement

Ismael, ColmenaresIsmael, Colmenares Joseph de Veyra Joseph de Veyra

Al GoytiaAl Goytia


2/55

StatisticsStatistics

CL +Palate 1 in 1000 live birthsCL +Palate 1 in 1000 live births(Aus)(Aus)

1 in 500 (Asians) 1 in 2000(African)1 in 500 (Asians) 1 in 2000(African)CP 1 in 2000 all racesCP 1 in 2000 all racesCL+P:CL:CP =2:1:1CL+P:CL:CP =2:1:1

Left:Right:Bilateral is 6:3:1Left:Right:Bilateral is 6:3:1


3/55

What went wrong?What went wrong?


4/55


5/55

Cleft LipCleft LipOral clefting occurs when the tissues of the lipOral clefting occurs when the tissues of the lipand/or palate of a fetus don't grow togetherand/or palate of a fetus don't grow togetherChildren with clefts often don't have enoughChildren with clefts often don't have enoughtissue in their mouths,tissue in their mouths,

tissue they do have isn't fused together properlytissue they do have isn't fused together properlyto form the roof of their mouths.to form the roof of their mouths.A cleft lip appears as a narrow opening or gap inA cleft lip appears as a narrow opening or gap inthe skin of the upper lip that extends all the waythe skin of the upper lip that extends all the wayto the base of the nose. A cleft palate is anto the base of the nose. A cleft palate is anopening between the roof of the mouth and theopening between the roof of the mouth and thenasal cavity.nasal cavity.Some kids have clefts that extend through bothSome kids have clefts that extend through boththe front and rear part of thethe front and rear part of thepalates, while others have only partial clefting.palates, while others have only partial clefting.


6/55

The three common kinds of The three common kinds of cleftsclefts

1. cleft lip without a cleft palate1. cleft lip without a cleft palate2. cleft palate without a cleft lip2. cleft palate without a cleft lip

3. cleft lip and cleft palate together3. cleft lip and cleft palate together


7/55

Why it went wrong!Why it went wrong!

UnknownUnknownMedicationsMedicationsSmokingSmokingParental AgeParental AgeFamily HistoryFamily HistoryRacialRacialGenderGenderSyndromic(17.5%CP have Sticklers)Syndromic(17.5%CP have Sticklers)


8/55

Antenatal DiagnosisAntenatal Diagnosis


9/55


10/55

Surgery for Oral CleftingSurgery for Oral Clefting

Surgery is usually performed during the first 3 toSurgery is usually performed during the first 3 to6 months to repair cleft lip and between 9 and 146 months to repair cleft lip and between 9 and 14months to repair the cleft palate.months to repair the cleft palate.Both types of surgery are performed in theBoth types of surgery are performed in the

hospital under general anesthesia.hospital under general anesthesia.Cleft lip often requires only one reconstructiveCleft lip often requires only one reconstructivesurgery, especially if the cleft is unilateral.surgery, especially if the cleft is unilateral.

The surgeon will make an incision on each side of The surgeon will make an incision on each side of

the cleft from the lip to the nostril. The two sidesthe cleft from the lip to the nostril. The two sidesof the lip are then sutured together. Bilateral cleftof the lip are then sutured together. Bilateral cleftlips may be repaired in two surgeries, about alips may be repaired in two surgeries, about amonth apart, which usually requires a shortmonth apart, which usually requires a shorthospital stay.hospital stay.


11/55

Cleft palate surgery involves drawingCleft palate surgery involves drawingtissue from either side of the mouth totissue from either side of the mouth torebuild the palate.rebuild the palate.It requires 2 or 3 nights in theIt requires 2 or 3 nights in thehospital, with the first night spent inhospital, with the first night spent inthe ICU.the ICU.

The initial surgery is intended to The initial surgery is intended tocreate a functional palate, reduce thecreate a functional palate, reduce thechances that fluid will develop in thechances that fluid will develop in themiddle ears, and help the teeth andmiddle ears, and help the teeth andfacial bones develop properly.facial bones develop properly.In addition, this functional palate willIn addition, this functional palate willhelp speech development and feedinghelp speech development and feedingabilities.abilities.


12/55

Later surgeries are usually scheduledLater surgeries are usually scheduledat least 6 months apart to allow timeat least 6 months apart to allow timeto heal and to reduce the chances of to heal and to reduce the chances of serious scarring.serious scarring.It's wise to meet regularly with theIt's wise to meet regularly with theplastic surgeon to determine what'splastic surgeon to determine what's

most appropriate in your child's case.most appropriate in your child's case.Final repairs of the scars left by theFinal repairs of the scars left by theinitial surgery may not be performedinitial surgery may not be performeduntil adolescence, when facialuntil adolescence, when facialstructure is more fully developed.structure is more fully developed.Surgery is designed to aid inSurgery is designed to aid innormalizing function and cosmeticnormalizing function and cosmeticappearance so that kids will have asappearance so that kids will have asfew difficulties as possible.few difficulties as possible.


13/55

Fetal Lip RepairFetal Lip Repair


14/55

BirthBirth


15/55

Lip RepairLip Repair


16/55


17/55


18/55


19/55


20/55


21/55


22/55


23/55


24/55


25/55

Lip:post operativeLip:post operativemanagementmanagement

Arm splints for 10 daysArm splints for 10 daysBreast feed bestBreast feed bestSyringe feed,cup and spoonSyringe feed,cup and spoonAvoid hard teatsAvoid hard teatsHome at 24-48 hoursHome at 24-48 hoursIf required, sutures out at 1 weekIf required, sutures out at 1 week

Massage scar tds, warn about contractionMassage scar tds, warn about contraction


26/55

Bilateral Lip RepairBilateral Lip Repair


27/55


28/55


29/55

Palate repairPalate repair


30/55


31/55


32/55


33/55


34/55


35/55

Palate:post operative carePalate:post operative care

Risks are airway and bleedingRisks are airway and bleedingArm splintsArm splints

Clear fluids overnightClear fluids overnightSyringe, sipper cup,spoon soft diet asSyringe, sipper cup,spoon soft diet astoleratedtolerated

Home at 48-72 hrsHome at 48-72 hrsSecondary bleed at 7-8 daysSecondary bleed at 7-8 days


36/55

HearingHearing


37/55

Cleft PalateCleft Palate

97% have otitis media97% have otitis mediaEustachian tube dysfunction-Eustachian tube dysfunction-mechanism unknown ?mechanicalmechanism unknown ?mechanicalBest time for grommet insertion is 3Best time for grommet insertion is 3months (at time of Cleft lip repair ormonths (at time of Cleft lip repair or6 months if palate repaired only)6 months if palate repaired only)


38/55


39/55


40/55

Touch Ups Touch Ups


41/55

SpeechSpeech


42/55

SpeechSpeech

80% of CP patients have normal80% of CP patients have normalspeech after repairspeech after repair15% achieve acceptable speech after15% achieve acceptable speech aftertherapytherapy


43/55

Speech TherapySpeech Therapy

Kids with oral clefting may have troubleKids with oral clefting may have troublespeaking the clefting can make thespeaking the clefting can make thevoice nasal and difficult to understand.voice nasal and difficult to understand.Some will find that surgery fixes theSome will find that surgery fixes theproblem completely.problem completely.Catching speech problems early can be aCatching speech problems early can be akey part of solving them. A child with akey part of solving them. A child with acleft should see a speech therapistcleft should see a speech therapistbetween the ages of 18 months and 2between the ages of 18 months and 2years.years.Many speech therapistslike to talk withMany speech therapistslike to talk withparents at least once during the child'sparents at least once during the child'sfirst 6 months to provide an overviewfirst 6 months to provide an overview


44/55

After the initial surgery is completed,After the initial surgery is completed,the speech pathologist will see thethe speech pathologist will see thechild for a complete assessment.child for a complete assessment.

The therapist will evaluate developing The therapist will evaluate developingcommunication skills by assessing thecommunication skills by assessing thenumber of sounds the child makes andnumber of sounds the child makes and

the actual words he or she tries to use,the actual words he or she tries to use,and by observing interaction and playand by observing interaction and playbehavior.behavior.

This analysis helps determine what, if This analysis helps determine what, if any, speech exercises a child needsany, speech exercises a child needsand if further surgery is needed. Theand if further surgery is needed. Thespeech pathologist often will continuespeech pathologist often will continueto work with the child throughto work with the child throughadditional surgeries.additional surgeries.

Many kids will work with a speechMany kids will work with a speech --


45/55

SummarySummary

BirthBirth3 months-------------LIP3 months-------------LIP

6-9 months-----------PALATE6-9 months-----------PALATE4-8 Years-------------SPEECH4-8 Years-------------SPEECH8-10 Years-----------BONE GRAFT8-10 Years-----------BONE GRAFT

14-18 Years----------JAW , NOSE,SCAR14-18 Years----------JAW , NOSE,SCAR


46/55

Emotional and Social IssuesEmotional and Social Issues

Society often focuses onSociety often focuses onappearances, and thisappearances, and thiscan make childhood can make childhood

and, especially, the teenand, especially, the teenyears they mightyears they mightexperience painfulexperience painfulteasing that canteasing that candamage self-esteem.damage self-esteem.Part of the cleft palatePart of the cleft palateand lip treatment teamand lip treatment team

includes psychiatric andincludes psychiatric and

W


47/55

Ways to support:Ways to support: Try not to focus on the cleft and don't allow Try not to focus on the cleft and don't allowit to define who your child is.it to define who your child is. Create a warm, supportive, ands acceptingCreate a warm, supportive, ands acceptinghome environment, where each person'shome environment, where each person'sindividual worth is openly celebrated.individual worth is openly celebrated.

Encourage your child to develop friendshipsEncourage your child to develop friendshipswith people from diverse backgrounds.with people from diverse backgrounds.

The best way to do this is to lead by example The best way to do this is to lead by exampleand to be open to all people yourself.and to be open to all people yourself.

Point out positive attributes in others thatPoint out positive attributes in others thatdo not involve physical appearance.do not involve physical appearance. Encourage autonomy by giving your childEncourage autonomy by giving your childthe freedom to make decisions and takethe freedom to make decisions and take

appropriate risks, letting his or herappropriate risks, letting his or her


48/55

Having opportunities to make decisionsHaving opportunities to make decisionsearly on like picking out what clothes toearly on like picking out what clothes towear lets kids gain confidence and thewear lets kids gain confidence and theability to make bigger decisions down theability to make bigger decisions down theroad.road.Consider encouraging your child to presentConsider encouraging your child to presentinformation about clefting to his or her classinformation about clefting to his or her classwith a special presentation that you arrangewith a special presentation that you arrangewith the teacher.with the teacher.Or perhaps your child would like you to talkOr perhaps your child would like you to talkto the class. This can be especially effectiveto the class. This can be especially effectivewith young children.with young children.If your child does experience teasing,If your child does experience teasing,encourage discussions about it and be aencourage discussions about it and be apatient listener.patient listener.Provide tools to confront the teasers byProvide tools to confront the teasers byasking what your child would like to say andasking what your child would like to say andthen practicing those statements.then practicing those statements.If your child seems to have ongoing self-If your child seems to have ongoing self-esteem problems, contact a childesteem problems, contact a child


49/55

THANK YOU THANK YOU

Shake and Bake!Shake and Bake!


50/55


51/55


52/55


53/55


54/55


55/55

Cleft Lip Edited New Format

Documents

Transcript of Cleft Lip Edited New Format