Clue 1: Orient yourself
Does the guide permanently join the pieces?
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
Does the guide permanently join the pieces?
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: Presurgical molding changes the starting geometry before repair; it does not fuse tissue, and long-term benefits remain uncertain.
On your WebXam
Distinguishing what NAM does from how strong the evidence is
For life
Having a gene is not the same as using it.
Principle: Having it is not using it
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 guide jig aligns pieces before they are permanently joined
A jig is a temporary guide that holds pieces in the correct position. It helps alignment before glue, screws, or another permanent joint is added.
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 measurements change before fastening?
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
What evidence would be needed to know whether the early change lasts?
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.
- 1Does the guide permanently join the pieces?
- 2Which measurements change before fastening?
- 3What evidence would be needed to know whether the early change lasts?
Tier 1 check
Finish with the everyday model
Use the everyday picture to answer today's question in plain words: Does the guide permanently join the pieces?
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: Distinguish positioning from closure.
Rule 2: Measure the preoperative change.
Rule 3: Separate short-term geometry from long-term function and appearance.
Where the analogy stops: Infant tissues grow and respond biologically. They are not rigid workshop pieces.
Carry the previous idea forward
A cleft palate limits suction because the mouth cannot seal from the nose, so feeding support changes flow rather than blaming effort.
Today's technical takeaway
Presurgical molding changes the starting geometry before repair; it does not fuse tissue, and long-term benefits remain uncertain.
Now map the same rules onto biology
Evaluate nasoalveolar molding for Mateo
Guide jig
Nasoalveolar molding appliance
Aligned pieces
Changed alveolar and nasal position
Final fastening
Later surgical repair
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
ANA07-E1
The supplied model shows Mateo's alveolar gap narrowing during monitored appliance use.
Why it matters: The starting geometry can change before lip repair.
ANA07-E2
The appliance does not create tissue fusion or replace surgery.
Why it matters: Molding is positioning, not closure.
ANA07-E3
Systematic reviews report low or very low certainty for many long-term outcomes.
Why it matters: Short-term narrowing should not be sold as a guaranteed lifelong benefit.
Make the clinical decision
You are the team orthodontist counseling Mateo's parents.
The family can attend frequent visits but was told molding will permanently fix the cleft and prevent all later surgery.
AOffer it as an optional positioning tool with workload and evidence limits explained.
BPromise permanent closure and no later surgery.
CSay the appliance cannot change any preoperative measurement.
Choose the counseling statement and cite one measured benefit plus one uncertainty.
Evidence required
ANA07-E1 + ANA07-E2 Claim ceiling
You may describe short-term positioning evidence. You may not guarantee long-term appearance, function, or fewer operations.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 7: Shaping the Gap Before Surgery
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
- 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.
If not, review
Today's new idea is only
Nasoalveolar molding does not close the ; it changes the starting position, and a good scientist holds both the promise and the uncertainty.
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.
Know by the end
- 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.
1
What NAM does
Model start: NAM is presurgical infant orthopedics: a custom plus a used in the first weeks of life.
- 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 .
2
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.
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: Nasoalveolar molding does not close the ; it changes the starting position, and a good scientist holds both the promise and the uncertainty.
Words to unlock first
nasoalveolar molding (NAM)molding platenasal stentgingivoperiosteoplastycolumella
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 · Structure and function; orthodontic and skeletal form
WebXam domain
Molecular and Genetic Technology
Evidence to produce
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.
Lab / skill
Human Body Systems (HBS) · Biomedical Innovations (BI)
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.
- Esenlik et al. 2020, NAM Therapy: Evidence-Based Results (CPCJ)
- Yarholar et al. 2021, NAM Cleft Protocol: Long-Term Outcomes to Facial Maturity (Plast Reconstr Surg)
- Rossell-Perry et al. 2020, Surgical NAM for Bilateral Cleft and Systematic Review (PRS Glob Open)
- 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.
How this is graded (rubric)
For: 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.
| 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 "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 attached to your class form or handed in, and confirmed.
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.