WHAT CAUSES CLEFT LIP

 

DEFINITION:

Cleft lip is a congenital crack or fissure which almost invariably affects the upper lip and could either be unilateral or bilateral on both sides of the upper lip.

The crack or the fissure results from the failure of the maxillary and pre-maxillary process to fuse during the 5^th to the 8thy weeks of intrauterine life. The cleft may be a simple notch in the vermilion line or it may be extended up into the floor of the nose.

INCIDENCE

Cleft lip occurs in about one out of every eight hundred (800) live births and it is most common in males than in females.

AETIOLOGY

The causes of left lip are not entirely clear. However, it appears to be genetically influenced, it also does occur in isolation with no genetic history.

Other predisposing factors include maternal viral infections such as rubella, exposure to excessive radiation during fetal life, alcoholism, oxygen and vitamin deficiency and cortision intoxication.

PATHOPHYSIOLOGY

Development of the upper Lip is characterized by fusion of the maxillary prominences with the lateral and medial nasal prominences. This process starts during the fourth (4^th) week of gestation and is complete by the seventh (7^th) week. Failure of mesenchymal migration to unite one or both of the maxillary prominences with the medial nasal prominences results in a unilateral or bilateral cleft of the lip, respectively.

CLINICAL MANIFESTATION

1.      The physical appearance of the child sufficiently confirms the diagnosis. The new born presents a facial deformity with an un- united upper lip which may or may not extend to the nose.

2.      There may be nasal distortion

3.      There is difficulty in feeding

COMPLICATIONS

BEFORE SURGERY:

1.      Speech impairment

2.      Improper tooth placement

3.      Impaired social adjustment

4.      Infections such as otitis media

5.      Hearing loss

AFTER SURGERY:

1.      Severe pain after surgery

2.      Bleeding from the invasion site

3.      Infection of the incision site

TREATMENT

Treatment is by surgical repairs. This can aid the baby to suck. Modification of the palate can also mould the cleft into correct alignment before surgical closure. It usually gives superior cosmetic results. The child has to gain a weight of about ten (10) pounds, has haemoglobin level of 10mg/dl or more and the child is about ten (10) weeks or more. In the theatre, the edges of the lip are paired together with stitches and the wound is painted with either iodine or methylated spirit.

NURSING MANAGEMENT

PRE-OPERATIVE CARE:

1.      Admit the child for a period of one (1) week or two (2).

2.      Observe child for the presence of catarrh which should be treated before surgery if present.

3.      The child should be trained in spoon feeding. Place the spoon far to the back of the mouth before pouring out the breast milk. The child’s response to this type of feeding should be satisfactory before surgery.

4.      Systemic antibiotics are given to combat any secondary infections.

5.      Support parents by reassuring them that, reparative surgery can be done with much success

6.      Make sure the consent form is signed by the parents.

7.      Tell mother to fast baby at 6:00am.

8.      The child’s temperature, pulse and respiration are monitored every four (4) hours and recorded.

POST OPERATIVE CARE:

1.      Split the child’s arms with a cardboard to prevent her from touching the wound or picking at the dressing.

2.      Administer paracetamol and suppository to reduce pain and temperature.

3.      Check vital signs such as temperature, pulse and respiration and record accurately.

4.      The mouth and nose are frequently cleaned to avoid infection of the incision site.

5.      The wound is usually swabbed or cleaned with sterile water or normal saline.

6.      Ensure rest and minimize crying to avoid the sutures from giving way. This can be achieved by ensuring that, the mother is always with the child, cuddling her whenever she cries.

7.      Some drugs such as chloral hydrate are given to the child to keep her quiet.

8.      Prevent people with nasal catarrh from visiting the child and all health staff caring for the child should be free from any sort of cold.

9.      Clean suture line after every feeding using saline water, tap gently and frequently with cotton tipped applicator and dry by patting.

10.  Position the child on her back or prop her on her side to keep her from rubbing her lip on the bed linen. An infant seat may be useful for variation of position comfort and entertainment should be provided.

11.  Provide diversional therapy by hanging attractive colourful toys, baby sound, music and flowers around the child’s bed.