Clue 1: Orient yourself
Which problem changes appearance?
Use the labels and the picture's left-to-right, near-to-far, or before-and-after order. Name only what you can point to.
The question
Which problem changes appearance?
Why it matters: Structure affects feeding, breathing, hearing, speech, teeth, and surgical planning. Care teams need to connect the exact structure to the function a child is using every day. Today you practice the professional reasoning behind that work: A unilateral cleft can distort nasal cartilage, base, and septum, so nose care addresses breathing and symmetry across growth.
On your WebXam
Recognizing the cleft nose as both an external deformity and an internal airway problem
For life
One result can have many causes; the outcome alone never tells you which.
Principle: Many roads, one ending
Five principles we return to
Having it is not using it
Same instructions, different switches
Same look, different cause
Change one thing and watch
Boss or doorman?
Decides the result or only allows it
Held down, not gone
Remove the brake and it returns
Many roads, one ending
One result can begin many ways
Try the everyday version first
A doorway can look uneven and also narrow the path through it
A doorway has both visible shape and usable space. An uneven frame may change appearance, limit passage, or do both.
Do not jump to the biology yet. Treat the picture as a small system. Track its parts, follow one change at a time, and keep more than one explanation open until the picture supplies a way to separate them.
Clue 2: Trace one change
Which problem limits passage?
Follow one object, stage, or path. Point to the first place where the situation changes instead of jumping to the ending.
Clue 3: Keep the cause open
Why might changing the wall below alter the doorway above?
List more than one explanation that still fits. Name the extra observation that would help you separate those possibilities.
Now inspect the illustration
Work from the visible evidence. A useful answer names the part of the picture that supports it and leaves unknown causes open.
- 1Which problem changes appearance?
- 2Which problem limits passage?
- 3Why might changing the wall below alter the doorway above?
Tier 1 check
Finish with the everyday model
Use the everyday picture to answer today's question in plain words: Which problem changes appearance?
You can complete today's required check without opening the technical details below.
Ready for the real names? Optional tier 2
Technical rules and limits
Rule 1: Assess external form and internal airway separately.
Rule 2: Coordinate nasal and jaw sequence.
Rule 3: Reserve definitive reshaping until growth and major jaw movement are settled.
Where the analogy stops: Nasal airflow and cartilage mechanics are more complex than a rigid doorway.
Carry the previous idea forward
Severe maxillary retrusion may require moving the upper jaw, but the choice between methods depends on severity, growth, stability, burden, airway, and speech.
Today's technical takeaway
A unilateral cleft can distort nasal cartilage, base, and septum, so nose care addresses breathing and symmetry across growth.
Now map the same rules onto biology
Map the cleft nose inside and out
Uneven frame
Alar and nasal-base asymmetry
Narrow passage
Septal deviation and airway obstruction
Moving wall below
Orthognathic change before definitive rhinoplasty
Educational illustration, not a clinical photograph, scan, or surgical plan. Use the labeled evidence cards and claim ceiling.
Mateo's case file: evidence supplied in this lesson
ANA17-E1
Mateo's left alar base is displaced and the nostrils are asymmetric.
Why it matters: The unilateral cleft affects external nasal form.
ANA17-E2
The supplied nasal examination shows septal deviation and greater resistance on one side.
Why it matters: The case includes a breathing concern, not appearance alone.
ANA17-E3
ACPA recommends waiting until skeletal maturity for definitive septorhinoplasty and usually completing indicated orthognathic surgery first.
Why it matters: Growth and jaw sequence can change the final nasal plan.
Make the clinical decision
You are the adolescent cleft-nose team lead.
Mateo requests definitive nasal surgery but is also scheduled for maxillary advancement next year.
ATreat urgent airway needs as indicated and plan definitive septorhinoplasty after jaw surgery and skeletal maturity.
BComplete definitive nasal reshaping first without coordinating jaw movement.
CDiscuss appearance only and ignore breathing.
Choose the sequence and cite airway plus timing evidence.
Evidence required
ANA17-E1 + ANA17-E2 Claim ceiling
You may explain the educational sequence. You may not decide a real patient's nasal procedure or timing.Go deeper Optional tier 3
Everything required for today is above. Open these only if you want the explainer, source trail, or download files.
The everyday model and Tier 1 check are the complete required path for this lesson.
Use these checks to keep your place. They are not turned in through the portal.
Check off as you finish
- Worked through the everyday picture and answered its three questions.
- Completed the Tier 1 check in plain words.
Turn in: Anatomical lesson 17: The Cleft Nose and Its Repair
Go to Schoology to turn this in.
Submit one PDF. Put your first and last name in the document header. Name the file: FirstName LastName - Assignment Title - YYYY-MM-DD.pdf.
Open Schoology PDF upload helpIf you cannot get in, see Mr. Mendoza. Do not skip the work.
Optional legacy technical materials Open only if you want the original notes, vocabulary, artifact, and CER work
Before this page, you should know
- Surgery that repositions the jaw bones is called ; it corrects the Class III bite and the flat profile together by moving the forward.
- The is a planned cut across the that frees the whole upper jaw so it can be moved forward and fixed with plates.
If not, review
Today's new idea is only
The same failed that split the lip unbalanced the nose inside and out, so the nose is a breathing problem as well as a shape problem, repaired definitively after growth.
Goal: Describe the (asymmetric ala, short or deviated , deviated septum) and explain why definitive rhinoplasty is timed to nasal growth.
Know by the end
- On the side the nostril is flattened and widened, the ala is pulled down and out, and the is short and leans toward the non-cleft side.
- Inside, the was deviated in about 92 percent of CL/P patients on CBCT, versus about 80 percent of non- controls.
- Sinus changes (mucosal thickening, smaller sinuses) and abnormal conchae are also more common in patients, so the cleft nose is also a breathing problem.
- Definitive is deferred until nasal growth is complete in the teen years, so later growth does not undo the repair.
1
The outside
Model start: The is present from birth: on the side the ala is flattened and displaced and the is short, leaning toward the non-cleft side.
- The strip of skin and between the two nostrils is the ____, which is short and leaning on the side.
- The normal nose target differs by ____, so there is no single universal ideal shape.
2
The inside
- The wall dividing the two nasal passages is the nasal ____, deviated in about 92 percent of CL/P patients on CBCT versus about 80 percent of controls.
- A deviated septum and abnormal conchae can block airflow, so the nose is also a ____ problem.
3
Timing the repair
- Definitive ____ is deferred until nasal growth is complete in the teen years, so later growth does not undo it.
Everything you need for today is on this page. These links are optional.
What to read
Read the short plain-language explanation written for this lesson. Plain-language explainer for this lesson
Why this source matters
This explanation gives you the background for today's idea without making you decode a research paper: The same failed that split the lip unbalanced the nose inside and out, so the nose is a breathing problem as well as a shape problem, repaired definitively after growth.
Words to unlock first
cleft nasal deformitynasal septumseptal deviationcolumellaseptorhinoplasty
Reading moves
- Skim the title and abstract first to get the gist.
- Circle the one sentence that states the main claim.
- Box the evidence the authors give for that claim.
- Mark one sentence that confuses you, and move on.
Stop point
Stop after the final 'Use it now' section. The research citations are available separately for advanced readers.
Your output
Write one claim-evidence sentence: state the main idea, then name the example or evidence that supports it.
Where this fits
Tested on (Ohio WebXam)
Genetics of Disease · 072130
PLTW lesson
MI · Anatomical domain · Respiratory system; structure of the nasal airway
WebXam domain
Molecular and Genetic Technology
Evidence to produce
Chart Mateo's nose. Sort four findings into "outside the nose" or "inside the nose": flattened left ala, deviated septum, short columella, thickened sinus lining. Then write one sentence recommending when to do his definitive septorhinoplasty and why that timing.
Lab / skill
Human Body Systems (HBS)
Everything required for today's decision is already in the case file and plain-language explainer. The links below are original papers and database records for teachers and advanced readers, not assigned student reading.
- American Cleft Palate Craniofacial Association. 2024 Parameters of Care.
- Goksel & Ozcan 2023, CBCT Study of Osteomeatal Complex Variations in CLP (Cleft Palate Craniofac J)
- Paknahad et al. 2022, Maxillary Sinus Characteristics in CLP Using CBCT (Cleft Palate Craniofac J)
- Harrison et al. 2024, 3D Analysis of Racial and Ethnic Differences in Cleft Nasal Deformity (Cleft Palate Craniofac J)
- Claim: Mateo's affects both the outside and the inside of his nose.
- Evidence: Give one outside finding and one inside finding, with a number for the inside one.
- Reasoning: Explain why the same produces both, and why definitive nose repair waits until the teen years.
How this is graded (rubric)
For: Chart Mateo's nose. Sort four findings into "outside the nose" or "inside the nose": flattened left ala, deviated septum, short columella, thickened sinus lining. Then write one sentence recommending when to do his definitive septorhinoplasty and why that timing.
| Criterion | Proficient | Developing | Beginning |
|---|---|---|---|
| Complete | Every required part of the artifact is present and filled in. | Most parts are present, but one is missing or left blank. | Several parts are missing. |
| Accurate | The science and data are correct and match the evidence. | Mostly correct, with a small factual slip. | Key science or data is wrong. |
| Scientific reasoning (CER) | States a claim, backs it with specific evidence, and explains the reasoning. | Has a claim and evidence, but the reasoning is thin or missing. | Gives an answer with no evidence or reasoning. |
| Professional communication | Clear, organized, and labeled the way a clinician or scientist would write it. | Readable but disorganized or missing labels. | Hard to follow. |
| Submitted | Turned in through the route named under Submit here and confirmed. | Turned in, but in the wrong place or unconfirmed. | Not turned in. |
How the model answer scores against this rubric
- CompleteProficient: Nothing is left blank: the model fills every part of "Chart Mateo's nose. Sort four findings into "outside the nose" or "inside the nose": flattened left ala, deviated septum, short columella, thickened sinus lining. Then write one sentence recommending when to do his definitive septorhinoplasty and why that timing.".
- AccurateProficient: Every number and claim matches the case evidence.
- Scientific reasoning (CER)Proficient: It names a claim, cites the specific evidence, and explains the reasoning, not just the answer.
- Professional communicationProficient: It is organized and labeled like a real chart note.
- SubmittedProficient: It would be attached to your class form or handed in, and confirmed.
What's next: We have now repaired lip, , bite, and nose. But some repairs do not fully hold. A hole can reopen in the roof of the mouth, and even a closed palate can let air leak into the nose during speech. What goes wrong after repair, and how is it fixed? We chase that next time.