the surgical correction of a congenital fissure in the midline of the partition separating the oral and nasal cavities. Palatal clefts range from a simple separation in the uvula to an extensive fissure involving the soft and hard palates and extending forward unilaterally or bilaterally through the alveolar ridge. A cleft lip often accompanies a cleft palate. Repair of a cleft palate is usually undertaken when a child is at least 6 months old and must be achieved before normal speech can be produced.
method Before surgery, properly sized elbow restraints to prevent the child from touching the mouth are prepared and sent to the operating room with the patient. After surgery the child is kept in a moist oxygen-rich environment by using a tent device (Croupette) until respirations are normal and is observed for signs of airway obstruction or excessive bleeding. Parenteral fluids are administered until the oral intake is adequate. Clear liquids and juices are given by cup only; straws, nipples, pacifiers, utensils, or toys may not be put into the mouth. Milk products and solids are contraindicated, but the kind of feeding ordered may vary. The child is fed in a high chair when possible, and a bib is used to accommodate drooling. Only circumoral mouth care is administered; the teeth are not brushed. Fluid intake and output are measured. The elbow restraints are worn continuously, except when daily range-of-motion exercises are performed and skin care is administered, to one arm at a time. With improvement the child is permitted to walk as tolerated.
interventions Before discharge the nurse ensures that the parents understand the required diet and the need to feed by cup only, to use elbow restraints, to maintain the motion and skin integrity of the arms, and to prevent injury to the mouth. The nurse reminds the parents to administer the required medication in the proper dosage and on schedule and to report symptoms of incision infection, such as drainage, mouth odor, or bleeding.
outcome criteria Depending on the extent and nature of a cleft palate, it may be repaired in one or in several operations. Some experts believe that early repair of a defect in the bony palate can lead to structural malrelations and advise delaying the operation until the child is between 5 and 7 years of age and has achieved more bone growth. Successful repair often greatly improves the child's oronasopharyngeal physiological function, speech, and appearance.