Research Paper Example on Cleft Palate

Oral facial clefts (OFCs) refer to various neonatal anomalies linked with structures located within the oral cavity that extends to the surrounding facial structures to cause craniofacial deformity. Research has shown that the main types of OFCs are cleft lip and cleft palate. The two kinds of OFCs present either part or both of craniofacial deformities and children affected with OFCs have medical problems such as nasal regurgitation, feeding difficulties as well as ear infections. Cleft defects also cause long-term psychological, financial as well as social effects to the affected babies. Even though OFCs can get repaired surgically, the scars that remain pose psychosocial problems to the affected individuals. The discussion of this research paper focuses on the cleft palate as one of the oral-facial clefts.

Definitions

Cleft palate refers to a congenital fissure found in the mouth roof when the palate fails to fuse entirely during embryo development. Cleft palate can extend to the whole palate or only the vulva depending on the level of incomplete fusion (Allam, Stone & Windsor, 2014). It may either be limited to outer fleshy part of the upper lip or extend to the middle line upper jaw of the baby. In some cases, the fissure may only involve the soft palate found at the rear parts of the mouth.

Etiology

The causes of cleft palate involve both the environmental and genital factors. Genetic factors increase the vulnerability of developing deformity. Genetically, cleft develops in an individual when a parent passes down genes that cause the disorder to their offspring (Dailey & Wilson, 2015). Studies have also shown that cleft palate occurs due to chromosomal duplications and deletions of phenotypes linked with partial aneuploidies. The other genetic cause of cleft palate is gene-gene interactions (Hilton, 2016). Interplay of various genetic factors contributes to the overall risk of cleft development.

Environmental factors increase the risks of a mother giving birth to an infant with cleft palate. Environmental factors such as maternal exposure to alcohols, tobacco products, viral infections, nutritional deficiencies as well as medications have been associated with the condition. Such factors interact with genetic factors to cause cleft palate (Allam et al., 2014). Research on the relationship between cleft palate and maternal smoking has led to positive results.

Pathophysiology

Pathophysiology of cleft palate relates to an interrupted formation of the facial structures during gestation. The embryonic development of palate occurs when the nasal septum fuses with the lateral palatal shelves starting from the 5th to the 12th weeks of pregnancy (Dailey & Wilson, 2015). Any interruption of the normal development of palatal before the 12th weeks of pregnancy leads to the formation of cleft palate.

Incidences and Mortality Rates

Available sources show that there is a variation of three-fold in the incidence at birth of children having a cleft palate. According to Dailey and Wilson (2015), Native Americans have the highest incidences of the cleft palate at 3.74:1000 while among the Whites, the rate ranges from 1:600 to 1:700 of live births. Among the Caucasians, the rate of cleft palate incidence is approximately 2:1000 live births. Statistics also show that cleft palate cases are higher in boys than in girls. Countries vary in the annual rates of cleft palate occurrences (Hilton, 2016). For instance, in America, almost 2650 infants are born having cleft palate each year.

Clinical Manifestations

Cleft palate presents with various specific signs and symptoms that makes it easy to diagnose. The first sign of cleft palate is the gap in the roof of the mouth; this is the most common clinical manifestation in babies and can lead to dental problems such as extra or missing teeth (Allam et al., 2014). The other sign is frequent infections of the middle ear as well the complication of the babies' Eustachian tubes. Dailey and Wilson (2015) stated that recurrent infection of the middle ear is as well happens because the fissure found on the roof of the mouth affects the normal functioning of the Eustachian tubes. Thirdly, the condition may present with speech problems; children having the disorder are not able to speak well. Hilton (2016) illustrated that problem of speech occurs because the gap affects the normal functioning of the lips and teeth when an individual speaks.

Diagnostics

Cleft palate can be diagnosed before the birth of the baby using an ultrasound. The practitioner uses ultrasound imaging technique to detect congenital disabilities in the fetus through the examination of the facial structures of the fetus. Cleft palate in the fetus can be detected from the 13th week of gestation (Dailey &Wilson, 2015). Continual development of fetus leads to the easier identification of cleft palate on the fetus by the use of ultrasound.

Further diagnostic tests involve the use of amniotic fluid to confirm the image shown during ultrasound imaging (amniocentesis). The fluid test helps in the identification of an inherited genetic syndrome that can lead to congenital disorders like cleft palate (McElroy et al., 2017).

Apart from prenatal ultrasound and amniocentesis that occurs before birth, diagnosis of cleft palate can take place after birth by visually examining the facial structure of the baby. Also, a detailed visual examination is a way of confirming the results of ultrasound image (Semb et al., 2017). In some cases, the presence of soft cleft palate may not be evident on the ultrasound image and can only get identified through visual assessment after birth.

Treatment

Cleft palate treatment involves both the closing of the gap and treating health complications that arise from the disorder. Firstly, the closure of the gap occurs through surgery which happens when the infant is between 6 and 12 months (Video, Knowledge, & Stats, 2017). The surgeon closes the gap while rearranging the palate using dissolvable stitches. Additional surgeries can occur to repair the scars.

The treatment of ear infections caused by cleft palate involves pharmacological management. Dailey and Wilson (2015) stated that treatment of the middle ear infections involves the use of antibiotics such amoxicillin. In addition, it is important to note that cleft palate causes social, psychological and aesthetic effects to children which may require the initiation of the non-pharmacological management techniques. Some of the non-pharmacological management includes having appropriate feeding techniques like the use of special feeder or bottle nipple, offering the affected individual speech therapy as well as psychosocial therapy (McElroy et al., 2017). For instance, treatments with a psychologist help a child in coping with stress caused by repeated medical and medical procedures like surgeries.

Nursing Implications

After birth, nurses ought to carry out head to toes examination to detect any congenital disabilities on the newborns. Stock and Feragen (2016) argued that a detailed visual assessment of the infant leads to early identification of cleft palate for appropriate procedure needed for treatment and management. In case a cleft palate is present, the nurses ought to assess its location as well as the extent using a finger that is gloved. Moreover, the nurses have to identify the feeding need of the infant by the location and extent of cleft palate and examine for the presence of the cleft palate. Also, the caregivers ought to assess the family members' level of understanding of the disorder (Allam et al., 2014). Lastly, as the child grows while waiting for surgery, the nurse should monitor it to identify any complication that may arise because of cleft palate like the middle ear infection.

Patient Education

The nurses have to educate the family about the care and the management of infants with cleft palate before and after surgery. The education ought to focus on feeding of the babies with cleft palate (Video et al., 2017). The caregivers and parents should be aware know how to use special feeders because of the feeding complication the children have. Secondly, the health caregiver ought to ensure that the mother is aware of how to breastfeed without chocking the baby. The other essential information to mothers having infants with cleft palate is knowledge on how to clear the airway of the baby. Also, the nurse has to educate the family members about the causes and management of the disorder (Stock & Feragen, 2016). Lastly, the nurse ought to educate the mother on how to reduce the chances of ear infections through appropriate breastfeeding positions.

Psychosocial Implications

Addressing the psychosocial problems likely to be encountered by parents of children with cleft palate helps in improving the efficacy of the treatment given to the child. As per Dailey and Wilson (2015), the health caregiver ought to consider the type of referrals that suit a case of an infant having a cleft palate. For instance, nurses can refer the patients to a pediatrician for special medical services. In case the mothers has stress because their childrens condition, a referral to a psychologist is appropriate. The parents may also be referred to the surgeons for surgical treatments. The economic impacts are other factors the nurses must consider when handling cleft palate case. The disorder is costly as it requires repeated medical procedures like surgeries (Allam et al., 2014). The nurse can advise the affected families to register for a medical insurance cover to reduce the burden of medical costs.

Conclusion

Cleft palate is one of the congenital disorders that remain unreported. The cause of cleft palate is due to an interaction between environmental and genital factors. Any interruption of the normal development of palatal before the 12th weeks of pregnancy leads to the formation of cleft palate. The common clinical manifestation of cleft palate is the presence of a gap in the roof of the mouth. Diagnosis of cleft palate occurs mostly before the birth of the baby using ultrasound. After delivery, analysis involves detailed visual assessment of the infant. The treatment of cleft palate involves both the closing of the gap and treating of health complications that arise from the disorder. Therefore, nurses ought to consider both the economic and psychosocial implications in the treatment and management of cleft palate.

References

Allam, E., Stone, C., & Windsor, L. J. (2014). Cleft lip and palate: etiology, epidemiology, preventive and intervention strategies. Anat Physiol, 4(3), 1-6.

Dailey, S., & Wilson, K. (2015). Communicating With a Cleft Palate Team: Improving Coordination of Care Across Treatment Settings. SIG 5 Perspectives on Speech Science and Orofacial Disorders, 25(1), 35-38.

Hilton, L. (2016). Cleft lip and palate: team approach to treatment. Contemporary Pediatrics, 33(7), 32-37.

McElroy, H., Habel, A., Jokinen, M., Marsh, C., Murphy, G., & Tuohy, W. (2017). Improving the early detection of cleft palate in the UK. Infant, 13(6).Semb, G., Enemark, H., Friede, H., Paulin, G., Lilja, J., Rautio, J., ... & Molsted, K. (2017). Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management. Journal of plastic surgery and hand surgery, 51(1), 2-13.Stock, N. M., & Feragen, K. B. (2016). Psychological adjustment to cleft lip and/or palate: A narrative review of the literature. Psychology & health, 31(7), 777-813.Video, S., Knowledge, S., & Stats, S. (2017). Parameters For Evaluation and Treatment of Patients With Cleft Lip/Palate or Other Craniofacial Differences. The Cleft Palate-Craniofacial Journal, 55(1), 137-156.