A Repaired Cleft Is Not a Cured Cleft
What can still go wrong for Mateo after his is repaired, and which team member is positioned to catch each problem?
💡 Each long-term complication has a different home specialist and a different detection method, which is exactly why care is delivered by a coordinated team over years.
Prerequisite check
- Orofacial clefting affects roughly 1 in 700 live births worldwide, on the order of 220,000 new cases globally per year.
- varies by population: highest in Asian and Amerindian (American Indian) populations (often around 1 in 500, up to about 4 per 1000), intermediate in European-derived populations (about 1 in 1000), lowest in African-derived populations (about 1 in 2500).
What you will learn
Goal: Students will identify the major long-term complications after repair (, , , otitis media with hearing loss, and ) and explain which team member catches each and how.
- An is a hole that reopens between mouth and nose after repair, causing nasal leakage; the surgeon finds it on exam.
- is the repaired failing to seal off the nose during speech ( dysfunction), causing ; the SLP catches it.
- is underdevelopment of the middle of the face after repair, causing bite problems in adolescence; the orthodontist and surgeon catch it, and it can be delayed by years.
- Otitis media with hearing loss (tensor veli palatini dysfunction) is caught by the audiologist and ENT, and , a particular concern where the airway is small as in Robin sequence, is caught by history and a sleep study.
Model: Five long-term complications, how they surface, and the muscles behind two of them
From the complications and care sections of the disease dossier (SYNTHESIS sections 4 and 7, DATA_TABLES section D), five complications can appear after repair. is a small hole that reopens between mouth and nose after repair; food or liquid leaks into the nose, found on exam by the surgeon. is the repaired palate still not sealing the nose during speech; and nasal air escape are caught by the . is the middle of the face growing too little after palate repair; bite problems and a flat midface in adolescence are caught by the orthodontist and surgeon. Otitis media with hearing loss is repeated middle-ear fluid; failed hearing checks and ear pain are caught by the audiologist and ENT. (OSA) is blocked breathing during sleep, especially relevant where the airway is small as in Robin sequence; snoring and breathing pauses are caught by history and a sleep study.
Two make more sense with the muscles from earlier lessons. VPI is dysfunction of the , the muscle that lifts the soft to close the nose off during speech; if the seal is incomplete after repair, air and sound escape, making speech hypernasal. Otitis media follows dysfunction of the tensor veli palatini, the muscle that opens the Eustachian tube to ventilate the ; when it fails, fluid builds up, infections recur, and hearing drops.
Explore (work the model before reading on)
- List the five complications. Next to each, write which team member catches it.
- Name the muscle behind VPI and the muscle behind otitis media.
- Three of the five (fistula, VPI, ) appear specifically after surgery. Explain why 'a repaired is not a cured cleft' is a fair summary.
- Each complication is caught by a different specialist using a different method. Why does catching all five require a whole team rather than a single doctor?
- shows up years after the repair, in adolescence. Predict why a problem caused by an early surgery might not become visible until the face has grown for a decade.
- In one sentence, what pattern did your team find about complications and how they are caught?
Guided notes
Surveillance, not the end of care
- Problems that can appear later are ______ (complications), and watching for them over years is surveillance.
- A successful early repair is the beginning of surveillance, not the end of care.
The five to know
- (caught by the surgeon) and VPI, from ______ veli palatini dysfunction (caught by the SLP).
- (orthodontist and surgeon), otitis media with hearing loss from tensor veli palatini dysfunction (audiologist and ENT), and , or ______ (history and sleep study).
Why it takes a team
- Each complication has a different home ______ and a different detection method.
- No single clinician can watch for all of them, which is why care is delivered by a coordinated team that follows the child for years.
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.
Vetted readings for this lesson
- Vyas T, et al. 2020. Cleft of lip and palate: A review. J Family Med Prim Care. [PMID:32984097]
- Dean KM, Leeper LK. 2020. Management of submucous cleft palate. Curr Opin Otolaryngol Head Neck Surg. [PMID:33105231]
- James JN, et al. 2014. Management of cleft lip and palate and orthognathic considerations. Oral Maxillofac Surg Clin North Am. [PMID:25438882]
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: Write Mateo's ten-year 'watch list' as a five-row table: complication, the specialist who owns it, and the one check or symptom that would catch it. Then add one sentence to his parents explaining, in plain language, why his cleft being 'fixed' does not mean his appointments are over.
- Wrote my Claim, Evidence, and Reasoning exit ticket.
Exit ticket (Claim, Evidence, Reasoning)
- Claim: Mateo will need ____ (no further / long-term) monitoring even after a successful repair.
- Evidence: Three post-repair complications and their catchers are: ____ (surgeon), ____ (SLP), and ____ (orthodontist and surgeon).
- Reasoning: Detecting these requires a coordinated team rather than one doctor because ____.
| 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 "Write Mateo's ten-year 'watch list' as a five-row table: complication, the specialist who owns it, and the one check or symptom that would catch it. Then add one sentence to his parents explaining, in plain language, why his cleft being 'fixed' does not mean his appointments are over.".
- 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 answered what can still go wrong and who catches it. But Mateo now needs a surgeon, a , an audiologist, an orthodontist, and more, all watching different things across many years. How does one team deliver all of this care without anything falling through the cracks?