Use of Vomer Flap in Palatoplasty: Revisited

Abstract

Objective

To present a new comprehensive and simple classification of vomerine flaps for palatoplasty.

Design

This classification has been developed on the basis of a literature search and our clinical experience. The vomerine flaps have been classified into three types, each with A and B subtypes.

Patients, Participants

Vomerine tissue has been used in more than 1000 palatoplasties over the past 17 years. The analysis includes 678 cleft palate patients for whom detailed records were available. Type II-A vomerine flaps were used most commonly in unilateral cleft palate patients, whereas Type II-B1 flaps were used in bilateral cleft palate patients.

Results

The overall fistula rate at the hard and soft palate junction was 2.95%. Although facial growth pattern was not recorded, obvious midface growth abnormalities were not observed in any of these patients.

Conclusions

Vomerine tissue is available in the vicinity of the palatal defect. Raising of the vomerine flap is simple and safe. If properly designed, it can be used judiciously for closure of the nasal and oral defects in the cleft palate. We have used these flaps only to augment the nasal mucosal defect. This comprehensive classification will be useful in understanding, designing, and implementing these small, but very important, flaps.