Shaping the Gap Before Surgery
Can we shape and narrow Mateo's before surgery, and how strong is the evidence that it helps?
💡 Nasoalveolar molding does not close the ; it changes the starting position, and a good scientist holds both the promise and the uncertainty.
Prerequisite check
- Normal feeding needs : a partial vacuum made by sealing the mouth and lowering the pressure inside it.
- Building that vacuum requires a closed chamber, and the roof of the mouth is the wall that seals the mouth off from the nose.
What you will learn
Goal: Explain how nasoalveolar molding narrows the alveolar gap and improves nasal symmetry before lip repair, and weigh the strength of the evidence behind it.
- uses a custom plus a in the first weeks of life to narrow the alveolar gap, realign the gum segments, lengthen the , and improve nasal symmetry.
- NAM does not close the ; it shapes soft, movable newborn so the surgeon's repair begins from a better position.
- In one long-term cohort, 85% had a and 57% of those avoided a later alveolar bone graft, with no significant harm to maxillary growth.
- The strength of the evidence is modest: benefits are confounded by surgical type and timing, and for clefts a found the evidence quality too low to be definitive.
Model: What molding does, and three findings on whether it helps
uses a custom intraoral plus a in the first weeks of life. Over weeks the plate is adjusted to narrow the alveolar (gum) gap by guiding the bony segments toward each other, reposition the segments into better , lengthen the (the strip between the nostrils, which matters most in clefts), and improve nasal symmetry by supporting the flattened nostril. This is not surgery; it is slow, controlled shaping of that is still soft in a newborn.
Three real findings on whether it helps. An evidence review found NAM reduces the severity of the deformity before surgery, can improve surgical outcomes, may reduce the need for revision, and does not appear to harm long-term facial growth, but benefits are confounded by surgical type and timing. A long-term cohort to facial maturity found 85 percent underwent , of whom 57 percent did NOT later need an alveolar bone graft, with no significant adverse effect on upper-jaw position. A of clefts concluded the quality of evidence was too low to draw definitive conclusions about the nasal and lip benefit.
Explore (work the model before reading on)
- List the four things a and are used to change before surgery.
- In the long-term cohort, what fraction of children who had a gum procedure avoided a later bone graft?
- Why would narrowing the alveolar gap before surgery make the lip repair easier and the scar narrower?
- Two sources are enthusiastic and one is cautious. What does the add that the single cohort cannot?
- NAM takes weeks of frequent clinic visits and committed caregivers. Predict one situation in which NAM might be right on paper but hard to deliver.
Guided notes
What NAM does
- NAM narrows the ____ gap, realigns the gum segments, lengthens the ____ (especially in clefts), and improves nasal symmetry.
- NAM does not close the ; it changes the starting ____ so the repair begins from better-aligned .
The evidence, honestly
- In one cohort, 85% had a and ____% of those avoided a later bone graft.
- The strength of the evidence is ____ (modest): benefits are confounded by surgery type and timing, and for clefts the quality was too low to be definitive.
Reading the Research
- 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.
Vocabulary (the same words your classes use)
Track your progress today
Check these off as you work through the lesson, then submit. This tells Mr. Mendoza how you're doing so he can help the class. It does not replace turning in your producible.
Use the code Mr. Mendoza gave you, not your name. Saved on this device.
- Read the Model and answered the Explore questions.
- Filled in the guided notes in my own words.
- Defined the new vocabulary with an example.
- Built the producible: Present to the cleft team in four sentences whether to start NAM for Mateo: (1) name at least one concrete benefit with its source, (2) state honestly one limitation of the evidence with its source, and (3) note one practical demand NAM places on the family. End with a clear recommendation, not a hedge.
- Wrote my Claim, Evidence, and Reasoning exit ticket.
Exit ticket (Claim, Evidence, Reasoning)
- Claim: NAM is worth doing for Mateo before lip repair.
- Evidence: Cite one benefit finding and one cautionary finding from the models.
- Reasoning: Explain why a smaller gap at the start helps the surgeon, and why honest uncertainty does not cancel the recommendation.
| 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 the right way (Schoology for routine work) and confirmed. | Turned in, but in the wrong place or unconfirmed. | Not turned in. |
- CompleteProficient: Nothing is left blank: the model fills every part of "Present to the cleft team in four sentences whether to start NAM for Mateo: (1) name at least one concrete benefit with its source, (2) state honestly one limitation of the evidence with its source, and (3) note one practical demand NAM places on the family. End with a clear recommendation, not a hedge.".
- 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 turned in on Schoology and confirmed.
Where this leads: careers
What's next: We have shaped Mateo's into a better starting position and kept him feeding. The gap is narrower, but it is still open. How does the surgeon actually rebuild the lip, and especially the ring of muscle inside it, into a working, symmetric whole? We chase that next time.