Cleft palate are congenital malformations resulting from the failure of fusion of maxillary processes during intrauterine development. Cleft palate are common birth defect in which a part of the lip and palate doesn’t completely come together or close while the baby is developing in the womb and so a split or cleft is left is in that area. Sometimes they are part of syndrome of birth defects. Cleft palate occurs in female approximately in 1in 2500 birth.1 This abnormality appears to run in families and therefore to be influence by hereditary, but no genetic factors may also be involved. Babies with the cleft lip/cleft palate need special care to ensure proper feeding and prevent complication. Surgery is done to close the cleft lip and cleft palate. Cleft lip is usually repaired by age 3 months, cleft palate by 1 years.2
A 2 year 8 Month 27 days female child was admitted in hospital with known case of bilateral premaxilla in bilateral cleft lip palate, therefore baby was admitted for cleft palate surgery, there is no history of cough cold and fever. Bilateral cleft was operated 6 months back. During admission her family knew about the procedures / surgery. Her vitals were: Temperature 980, Respiratory rate is 26/ min Blood pressure 90/60 mm Hg Spo2- 98% Central nervous system was conscious, oriented.
Physical Problem: I found that the child had difficulty in swallowing, speech problem according to her age group she only speak few word like mama, papa, yes and no, nasal sounding voice, hard and soft palate facial defect, dental problems like poor oral hygiene, halitosis.
Psychological Problem: child was anxious, low self-confidence, child presented temper tantrum, child was self-involved, and lack of interest in surrounding
Psychological Problem: Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care.
Date of surgery 11/08/2021
Preoperative diagnosis: bilateral cleft palate with protruded premaxilla.
Procedure performed: cleft palate repaired + vomerine setback
Post operative period — during the post-operative periods all vitals were monitored and was stable, there is no oozing, bleeding from suture site. And child had smooth recovery.
Cleft plate result from failure of fusion of the hard with each other and with the soft plate. Cleft plate may be complete (Involving hard and soft plate, possibly including a gap in the palate) or incomplete (A hole in the roof of the mouth, usually in soft palate). palatoschisis
Cleft lip plate are basically divided in two category
The incidence rate of cleft lip plate is 1 in 2500 births. And it is predominantly seen in Female approximately 15 % of the affected infant have associated with this defect. Cleft palate are facial malformation that occurs in fetus very early in pregnancy, while the baby is developing inside mother’s womb. In most Cassese, the cause is unknown. Most of the physician believe that cleft plate are occurs due to combination of genetic and environmental factors.
Bilateral cleft palate with protruded premaxilla is a rare congenital anomaly, which occurs in fetus during developing in mother’s womb. It is mostly found in female, in most cases, the cause is unknown. The chance of cleft in newborn is more, if a parent or sibling has had the problem. The problem can be identified after birth of baby. Surgical management is the only way to treat condition. The first surgical repair usually occurs when the baby is between 6-12 months. This initial surgery was done for functional closer of palate, therefore it will reduce the chance of fluid entering middle ear.3
The child was 2 year 8 Month old admitted in hospital with known case of bilateral premaxilla in bilateral cleft lip palate, therefore baby was admitted for cleft palate surgery, Bilateral cleft was operated 6 months back. During admission her family knew about the procedures, Child was operated Bilateral cleft palate with protruded premaxilla and Cleft palate repaired + Vomerine setback operative procedure was performed.
The baby was admitted with the above –mentioned complaints. Admitted for cleft palate surgery. Blood investigation before surgery suggestive of hb-9.7, pcv-30.8, TLC-12970, platelets- 3.97, CRP-1.96, creatinine-0.52. fitness for surgery was done by pediatrician. The baby shifted OT for bilateral cleft palate surgery on 11/08/2021. The child underwent the procedure under GA and post –op, shifted to PICU for recovery. All vitals monitored and child had a smooth recovery.4 once oral feeds were established, child was shifted to wards same treatment continued in the wards. Ward stay was uneventful. There is no oozing, bleeding from suture site. Wound is healthy. At the time of discharge child is active, afebrile, accepting orally well, hemodynamically stable, passing urine and stool normally. Child was ask to come to follow up after 15 days.5, 6