Вы находитесь на странице: 1из 65

Cleft Lip And Palate

Management

Ismael, Colmenares
Joseph de Veyra
Al Goytia
Statistics
 CL +Palate 1 in 1000 live births
(Aus)
 1 in 500 (Asians) 1 in 2000(African)
 CP 1 in 2000 all races
 CL+P:CL:CP =2:1:1
 Left:Right:Bilateral is 6:3:1
What went wrong?
Cleft Lip
 Oral clefting occurs when the tissues of the lip
and/or palate of a fetus don't grow together
 Children with clefts often don't have enough
tissue in their mouths,
 tissue they do have isn't fused together properly
to form the roof of their mouths.
 A cleft lip appears as a narrow opening or gap in
the skin of the upper lip that extends all the way
to the base of the nose. A cleft palate is an
opening between the roof of the mouth and the
nasal cavity.
 Some kids have clefts that extend through both
the front and rear part of the
 palates, while others have only partial clefting.
The three common kinds of
clefts

1. cleft lip without a cleft palate


2. cleft palate without a cleft lip
3. cleft lip and cleft palate together
Why it went wrong!
 Unknown
 Medications
 Smoking
 ParentalAge
 Family History
 Racial
 Gender
 Syndromic(17.5%CP have Sticklers)
Antenatal Diagnosis
Surgery for Oral Clefting

 Surgery is usually performed during the first 3 to


6 months to repair cleft lip and between 9 and 14
months to repair the cleft palate.
 Both types of surgery are performed in the
hospital under general anesthesia.
 Cleft lip often requires only one reconstructive
surgery, especially if the cleft is unilateral.
 The surgeon will make an incision on each side of
the cleft from the lip to the nostril. The two sides
 of the lip are then sutured together. Bilateral cleft
lips may be repaired in two surgeries, about a
month apart, which usually requires a short
hospital stay.
 Cleft palate surgery involves drawing
tissue from either side of the mouth to
rebuild the palate.
 It requires 2 or 3 nights in the
hospital, with the first night spent in
the ICU.
 The initial surgery is intended to
create a functional palate, reduce the
chances that fluid will develop in the
middle ears, and help the teeth and
facial bones develop properly.
 In addition, this functional palate will
help speech development and feeding
abilities.
 Later surgeries are usually scheduled
at least 6 months apart to allow time
to heal and to reduce the chances of
serious scarring.
 It's wise to meet regularly with the
plastic surgeon to determine what's
most appropriate in your child's case.
 Final repairs of the scars left by the
initial surgery may not be performed
until adolescence, when facial
structure is more fully developed.
 Surgery is designed to aid in
normalizing function and cosmetic
appearance so that kids will have as
few difficulties as possible.
Fetal Lip Repair
Birth
Lip Repair
Bilateral Lip Repair
Lip:post operative
management
 Arm splints for 10 days
 Breast feed best
 Syringe feed,cup and spoon
 Avoid hard teats
 Home at 24-48 hours
 If required, sutures out at 1 week
 Massage scar tds, warn about contraction
Palate repair
Palate:post operative care
 Risks are airway and bleeding
 Arm splints
 Clear fluids overnight
 Syringe, sipper cup,spoon soft diet as
tolerated
 Home at 48-72 hrs
 Secondary bleed at 7-8 days
Hearing
Cleft Palate
 97% have otitis media
 Eustachian tube dysfunction-
mechanism unknown ?mechanical
 Best time for grommet insertion is 3
months (at time of Cleft lip repair or
6 months if palate repaired only)
Touch Ups
New surgical technique promises
hope for Cleft Palate Patients
 A Mayo Clinic laboratory study in animals suggest
that using distraction osteogenesis, a procedure
that uses
the mechanical force of an appliance to lengthen
soft tissue and bone, may be a feasible and
effective method to repair cleft palate in the
future

 The distraction osteogenesis method is designed


to gradually lengthen the bone of the palate
through tension.

 An appliance made of a central body piece, four


plates and screws is
surgically inserted with the patient under
anesthesia.
 After a rest period of 10 days, a key
in the appliance is turned slightly
each day for four weeks to slowly
lengthen the bone and soft tissue.
Finally, the device is surgically
removed.
 Currently, standard treatment for
cleft palate repair involves surgery in
which the mucosal flaps of the roof of
the mouth
are sewn together over the cleft.
 The actual missing bone is not
repaired.
Problems associated with the
current Cleft Palate surgery
method
 Leaves exposed areas of hard palate bone,
producing scars that sometimes interfere
with the child's later midfacial growth.
 Poor cosmetic appearance is usually the
result of midfacial growth and can result in
poor contact between lower and upper
teeth when the child's mouth is closed.
 An increased risk of the wound splitting
open or the creation of an abnormal
passage between the
mouth and nose is a possibility.
 The current repair method also may
shorten and scar the soft palate, which
can impair speech.
Laboratory Trials
 Thestudy of this method of cleft palate
repair was conducted on 10 adult hounds,
due to similarities to the human mouth.

 Twohounds served as study controls and


had a surgically created cleft palate, but
no subsequent repair.

 Inthe other eight hounds, the distraction


osteogenesis device was used to close the
cleft palate.
Laboratory Results
 In 7 of the 8 hounds that were treated,
researchers observed some degree of bony
closure of the cleft; in 5 of them the cleft was
closed completely with no side effects.

 The researchers are currently working on


perfecting the technique through study of the
hounds with incomplete
closure.

 The researchers also felt that the distraction


osteogenesis device used in this study was too
bulky, so they are now testing another more agile
apparatus, says Dr. Moore. (Eric Moore, M.D.,
Mayo Clinic otorhinolaryngologist and one of the
study's investigators.)
Help International
 Help International travels with a team
coming from Cedars Sinai
 The trip is 10 days in total including 5 days
of surgery.
 Each day the team performs about 130
surgeries and work around 13 hrs.
 Their days starts around 6 am and ends at
10pm by the time they get to camp.
 They provide their own supplies from or
tables to instruments to portabe
anesthesia.
 The whole team includes around 110 people
from surgeons to cooks. T
 The program is completely voluntary and
each person spends around $1700 out of
their own pocket to go.
 According to one of them, it is really
rewarding to the staff to know they help
people that otherwise would not have the
opportunity to have this kind of surgery.
Speech
Speech
 80% of CP patients have normal
speech after repair
 15% achieve acceptable speech after
therapy
Speech Therapy

 Kids with oral clefting may have trouble


speaking — the clefting can make the
voice nasal and difficult to understand.
Some will find that surgery fixes the
problem completely.
 Catching speech problems early can be a
key part of solving them. A child with a
cleft should see a speech therapist
between the ages of 18 months and 2
years.
 Many speech therapistslike to talk with
parents at least once during the child's
first 6 months to provide an overview
 After the initial surgery is completed,
the speech pathologist will see the
child for a complete assessment.
 The therapist will evaluate developing
communication skills by assessing the
number of sounds the child makes and
the actual words he or she tries to use,
and by observing interaction and play
behavior.
 This analysis helps determine what, if
any, speech exercises a child needs
and if further surgery is needed. The
speech pathologist often will continue
to work with the child through
additional surgeries.
 Many kids will work with a speech
Summary
 Birth
3 months-------------LIP
 6-9 months-----------PALATE
 4-8 Years-------------SPEECH
 8-10 Years-----------BONE GRAFT
 14-18 Years----------JAW , NOSE,SCAR
Emotional and Social Issues

 Society often focuses on


appearances, and this
can make childhood —
and, especially, the teen
years — they might
experience painful
teasing that can
damage self-esteem.
 Part of the cleft palate
and lip treatment team
includes psychiatric and
Ways to support:
 • Try not to focus on the cleft and don't allow
it to define who your child is.
 • Create a warm, supportive, ands accepting
home environment, where each person's
individual worth is openly celebrated.
 • Encourage your child to develop friendships
with people from diverse backgrounds.
 The best way to do this is to lead by example
and to be open to all people yourself.
 • Point out positive attributes in others that
do not involve physical appearance.
 Having opportunities to make decisions
early on — like picking out what clothes to
wear — lets kids gain confidence and the
ability to make bigger decisions down the
road.

 Consider encouraging your child to present


information about clefting to his or her class
with a special presentation that you arrange
with the teacher.

 Or perhaps your child would like you to talk


to the class. This can be especially effective
with young children.

 If your child does experience teasing,


encourage discussions about it and be a
patient listener.
 Encourage autonomy by giving your child
the freedom to make decisions and take
appropriate risks, letting his or her
accomplishments lead to a sense of value.
 Provide tools to confront the teasers by
asking what your child would like to say
and then practicing those statements.
 If your child seems to have ongoing self-
esteem problems, contact a child
psychologist or social worker for support
and information. Together with the
members of the treatment team,you can
help your child through tough times.
Web Sites
 Wide Smiles Web Site
      Cleft Lip and Palate Resource
 The Cleft Lip and Palate Association - United
Kingdom
      This site answers some of the most commonly
asked questions about cleft lip and palate and
provides information on the services and advice
offered by CLAPA - The Cleft Lip and Palate
Association.
 Cleft Lip and Palate Association of Ireland
      A voluntary group formed to provide support
and information for parents of children affected
by cleft lip and palate and those directly affected
by the condition.
 Prescription Parents
      Parents helping Parents of children with cleft
lip & palate
 Smiles
      "SMILES" is a group of dedicated
families who have developed a first-hand
understanding of the needs of children
with cleft lip, cleft palate and craniofacial
deformities.
 Cleft Palate Foundation
      A non-profit organization dedicated to
optimizing the quality of life for individuals
affected by facial birth defects.
THANK YOU

Shake and Bake!