Management of bilateral cleft lip and palate

Annaselvi1*, Subathra Devi2, M, Maha Lakshmi3

1OPD In -charge, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

Bilateral cleft lip and palate is a congenital craniofacial anomaly characterized by openings on both sides of the upper lip and the roof of the mouth. Early diagnosis and surgical intervention improve feeding, speech development, appearance, and overall quality of life. This case study discusses the management and outcome of an infant diagnosed with bilateral cleft lip and palate.

Key words: Bilateral cleft lip; Craniofacial

Introduction

Cleft lips and palate occur when facial structures fail to fuse properly during fetal development. Bilateral cleft lips involve a split on both sides of the upper lip, while cleft palate is an opening in the roof of the mouth. These conditions can affect feeding, speech, hearing, dental development, and psychosocial well-being.

Case Presentation

A female infant was diagnosed with bilateral complete cleft lip and palate. The condition was identified early and managed through a multidisciplinary team approach involving pediatricians, plastic surgeons, nurses, speech therapists, and dental specialists.

Relevant Clinical Findings

  • Allergies: Nil
  • Past Medical History: Nil
  • Past surgical history: Nil

Physical examination

  • Child active, alert, afebrile
  • PR: 84 bpm
  • Weight: 4.2 kg
  • CVS: S1S2 (+)
  • RS: Bilateral air entry (+)
  • P/A: Soft

L/E

  • Bilateral cleft lip (+)
  • Complete cleft palate (+)
  • Prolabium protruded
  • Nasal tip flattened

Relevant Investigation

Test(PT)12.6 Seconds11-04-25 10:26:00
Test(APTT)29.3 Seconds11-04-25 10:26:00
Control (PT)11.3 Seconds11-04-25 10:50:04
Control (APTT)27.0 Seconds11-04-25 10:50:04
INR1.12.11-04-25 10:26:00
Hepatitis C Antibody (Anti HCV)Non-Reactive (0.24)11-04-25 10:26:00
Hepatitis B Surface Antigen (HBsAg)Negative (0.20)11-04-25 10:26:00

Diagnosis: Bilateral Complete Cleft Lip and Palate (Veau Group IV)

Management

Surgery note: on 11.04.2025: Bilateral Cleft lip repair by modified Millard rotation – Advancement done under GA

  • Under GA
  • Parts painted & draped.
  • Markings of bilateral cleft lips done.
  • Philtral skin flap raised from the prolabium.
  • ‘C’ flaps raised on either side of the philtral flap.
  • Faulty insertion of alar cartilage dissected. Muscle detached from abnormal cleft insertion.
  • Bilateral lateral elements dissected and skin, orbicularis and mucosa separated.
  • Lateral alar skin and ‘C’ flaps are used to reconstruct the nasal floor using 5-0 prolus.
  • Mucosal flap from prolabium used to reconstruct gingivobuccal sulcus.
  • Orbicularis oris on either lateral element approximated and sutured by vicryl.
  • Skin of the lateral elements aligned and sutured with the philtral skin flap to reconstruct the cupid’s bow using 5-0 prolene.
  • Mucosa of the lateral elements and prolabium sutured using vicryl.
  • Bilateral nasal alar – Mc Comb’s stitch done using ethilon.

Supportive Management

  • Feeding assistance and nutritional support
  • Regular follow-up visits
  • Speech and language assessment
  • Dental and orthodontic planning

Outcome

  • Successful repair of cleft lip and palate
  • Improved feeding ability
  • Better facial appearance
  • Expected improvement in speech development with continued therapy
  • Good postoperative recovery

Nursing Management

Pre-operative Care

  • Assessing feeding pattern and nutritional status
  • Educate parents regarding surgery
  • Monitor weight gain and hydration
  • Provide emotional support

Post-operative Care

  • Monitor airway, breathing, and circulation
  • Assessing surgical site for bleeding or infection
  • Administer prescribed medications
  • Maintain oral hygiene
  • Educate parents regarding wound care and feeding precautions
  • Discharge Medications
  • Antibiotics as prescribed
  • Analgesics for pain management
  • Multivitamin supplementation if indicated
  • Follow-up instructions provided

Discharge medications

DrugDoseMorningAFNight
Syp.Augmentin228.5mg/5ml2.5ml-2.5ml
Syp.Para125mg2.5ml2.5ml2.5ml

Discussion 

Bilateral cleft lip and palate significantly affect feeding, speech, hearing, and facial appearance. Early surgical correction combined with multidisciplinary management improves functional and cosmetic outcomes. Family education and long-term follow-up play crucial roles in successful rehabilitation. Advances in surgical techniques have greatly enhanced patient outcomes and quality of life.

Conclusion

Bilateral cleft lips and palate is treatable congenital condition. Early diagnosis, timely surgical intervention, and comprehensive multidisciplinary care result in favourable outcomes. Continuous follow-up and family involvement are essential for optimal growth, speech development, and psychosocial well-being.

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