the surgical correction of a unilateral or bilateral congenital interruption of the upper lip, usually resulting from the embryological failure of the median nasal and maxillary processes to unite.
method A cleft lip may sometimes be repaired during the infant's first 48 hours of life, but some surgeons follow a "rule of 10s" and perform the operation when the child is 10 weeks old, weighs 10 or more pounds, and has a hemoglobin level of at least 10 g/dL. Before surgery, elbow restraints, used to prevent the infant from touching the incision, are prepared in the proper size and are sent to the operating room with the patient. After surgery the infant is maintained with ventilatory support as necessary until respirations are normal. Essential observations include assessment for respiratory stridor or obstruction, excessive bleeding, separation of the incision, and redness under the elbow restraints used to keep the hands from the mouth. The wire bow applied to the infant's upper lip and taped to the cheeks to prevent tension on the sutures is kept in place. If it becomes loose, it is reapplied with tincture of benzoin. The infant is given clear liquids and juices through a syringe (Asepto) or special feeding unit. Parenteral fluids are administered until oral intake is adequate. Milk products, solids, and a nipple or pacifier are not allowed. The diet and manner of feeding may vary, but the infant is fed while held with the head up or is placed in a cardiac chair and burped after the intake of each ounce of food. Fluid intake and output are measured. The elbow restraints are worn at all times except when range-of-motion exercises are performed, one arm at a time, while skin care is administered to that limb.
interventions The nurse provides preoperative and postoperative care and prepares for the infant's discharge by ensuring that the parents understand the proper diet and feeding schedule and technique. The nurse emphasizes the importance of using elbow restraints, maintaining motion and skin integrity of the arms, preventing injury to the surgical area, and reporting symptoms of infection, including separation of the incision, excessive swelling, redness, bleeding, and drainage.
outcome criteria Modern surgical techniques permit remarkable repair of cleft lips. In some cases a second operation is required to eliminate the scar.