Clue 1: Orient yourself
Why do all sections need the same score?
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
Why do all sections need the same score?
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: Cleft care is a coordinated timeline because each specialty acts when anatomy, function, and development make its decision useful.
On your WebXam
Applying the rule of growth to order cleft care steps by age
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
An orchestra follows one score, but different sections enter at different times
A shared score coordinates many instruments, but each section has its own entrance and job. The full piece depends on timing across the group.
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
What happens if one section enters too early?
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
Which signals tell a section when to act?
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.
- 1Why do all sections need the same score?
- 2What happens if one section enters too early?
- 3Which signals tell a section when to act?
Tier 1 check
Finish with the everyday model
Use the everyday picture to answer today's question in plain words: Why do all sections need the same score?
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: Coordinate around the patient's developmental stage.
Rule 2: Assign each decision to the right discipline.
Rule 3: Keep surveillance running between procedures.
Where the analogy stops: Cleft care is shared decision-making with a patient and family, not a performance controlled by one conductor.
Carry the previous idea forward
A fistula is a tissue opening, while velopharyngeal insufficiency is a moving-valve problem; each needs different evidence and treatment planning.
Today's technical takeaway
Cleft care is a coordinated timeline because each specialty acts when anatomy, function, and development make its decision useful.
Now map the same rules onto biology
Build Mateo's coordinated care timeline
Shared score
Interdisciplinary care plan
Section entrance
Age and development-linked specialty action
Ongoing rhythm
Longitudinal hearing, speech, dental, growth, and psychosocial surveillance
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
ANA19-E1
Mateo needs feeding and hearing support in infancy before definitive dental or jaw procedures.
Why it matters: Some needs are immediate while others depend on later development.
ANA19-E2
Lip and palate repair, speech review, grafting, orthodontics, jaw, and nasal decisions have different developmental triggers.
Why it matters: Sequence prevents conflicting or premature care.
ANA19-E3
ACPA recommends interdisciplinary coordination, family participation, and long-term outcome monitoring.
Why it matters: The team plan must remain shared and revisable.
Make the clinical decision
You are the cleft-team care coordinator.
A new family receives six separate specialty plans with conflicting dates and no owner for surveillance.
ACreate one shared timeline with responsible roles, triggers, and follow-up measures.
BLet every specialty schedule independently.
CList surgeries only and omit hearing, speech, dental, and family support.
Choose the coordination plan and place five supplied milestones in order.
Evidence required
ANA19-E1 + ANA19-E2 Claim ceiling
You may build the composite educational timeline. You may not imply that every patient needs every procedure.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 19: Who Does What, and When: Mateo's Care Timeline
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
- A is a residual or recurrent hole between the mouth and nose after repair; the pooled mean rate is about 9.94 percent and rises with .
- Fistula rate climbs from about 2 percent in Veau I to about 12.5 percent in Veau IV, with about 8.3 percent.
Today's new idea is only
Every step in care is timed by two rules: repair when it helps most and harms growth least, and keep watching hearing and speech on a schedule.
Goal: Build a staged, age-ordered timeline for a child with complete CL/P, naming who acts, when, and why each step is timed to growth and development.
Know by the end
- A child like Mateo is cared for by a multidisciplinary team working in a planned order called , each stage timed to growth, not a calendar date.
- The usual order is NAM in the first weeks, lip repair around 3 to 6 months, repair around 10 to 14 months, then ear and speech surveillance, then alveolar bone graft in the before age 9, then bite and nose at .
- The rule of growth: a structure is repaired at the age when the repair helps most and harms growth least.
- The rule of surveillance: some problems (hearing, speech) are watched on a schedule for years, not fixed once.
1
Staged care
Model start: A multidisciplinary team works in a planned order called , each stage timed to growth and development, not a fixed calendar date.
- NAM comes in the first ____ (weeks); lip repair around 3 to 6 months; repair around 10 to 14 months because delay worsens speech.
- The alveolar bone graft is done in the ____ , ideally before age 9.
2
The two rules
- The rule of ____ repairs a structure when it helps most and harms growth least.
- The rule of ____ watches hearing and speech on a schedule, rather than assuming one fix is the end.
3
An honesty note
- Minority and non-English-speaking children have measurable delays reaching surgery in some settings, which is an ____ point, not a biology point.
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: Every step in care is timed by two rules: repair when it helps most and harms growth least, and keep watching hearing and speech on a schedule.
Words to unlock first
multidisciplinary teamstaged caremixed dentitionskeletal maturitysurveillance
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 · Body systems working together across the lifespan; coordinated care
WebXam domain
Molecular and Genetic Technology
Evidence to produce
As the coordinator, put the eight care steps into a single age-ordered timeline for Mateo, from birth to the late teens. Next to each step write the leading specialist and one phrase saying why it sits there (for example, "before age 9 so the graft takes" or "after the face stops growing"). Mark the two steps that are surveillance, not one-time operations.
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.
- Lindeborg et al. 2020, Optimizing Speech Outcomes for Cleft Palate (Curr Opin Otolaryngol Head Neck Surg)
- Kimia et al. 2022, Secondary Alveolar Bone Grafting in UCLP and BCLP: 3D CBCT Evaluation (Plast Reconstr Surg)
- Zaluzec et al. 2019, Delay in Cleft Lip and Palate Surgical Repair: Cleft Health Disparities (J Craniofac Surg)
- Claim: A child like Mateo is treated in a planned order, not all at once.
- Evidence: Name three steps in the right age order and give the specialist for each.
- Reasoning: Explain, using the rule of growth, why the bone graft waits for the while the is repaired in infancy.
How this is graded (rubric)
For: As the coordinator, put the eight care steps into a single age-ordered timeline for Mateo, from birth to the late teens. Next to each step write the leading specialist and one phrase saying why it sits there (for example, "before age 9 so the graft takes" or "after the face stops growing"). Mark the two steps that are surveillance, not one-time operations.
| 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 "As the coordinator, put the eight care steps into a single age-ordered timeline for Mateo, from birth to the late teens. Next to each step write the leading specialist and one phrase saying why it sits there (for example, "before age 9 so the graft takes" or "after the face stops growing"). Mark the two steps that are surveillance, not one-time operations.".
- 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 can now lay every step out in order. But putting them in order means we have assembled the entire anatomical and surgical picture, from the first finding at birth to the last revision in the teens, and we have never once been handed a diagnosis. What is Mateo's complete anatomical and surgical story, told as one piece, and what does the whole picture finally tell us about what he has? We answer that next time.