The use of a Vomer Flap Covered with an Autogenous Skin Graft as A Part of the Palatal Repair in Children with Unilateral Cleft Lip and Palate

Abstract

The alveolar arch dimensions and the occlusion from the time of the lip closure operation to approximately 5 years of age were studied in two groups of children with complete unilateral cleft lip and palate. The major difference between the groups was the type of palatal surgery performed on them. In one group (VS), the hard palate was closed with a vomer flap covered with an autogenous skin graft and the soft palate was closed by medial displacement of soft tissue. The other group (LT) was selected from patients in whom the hard and soft palate were closed using a modified von Langenbeck technique. Using study casts made before lip closure the subjects in group LT were chosen in order to make the group as a whole as analogous as possible to the first group with respect to the size of the cleft and the size and the morphology of the alveolar process. Each group consisted of 11 children. Palatal closure was made at a mean age of 18 months in group VS and at a mean age of 21 months in group LT. From the time of lip closure to that of palatal closure the transverse width in the canine region increased 11% in group VS and 5% in group LT. From palatal closure to the age of about five, the width remained relatively unchanged in the two groups. From lip closure to palatal closure the inter-tuberosity width increased by about 5% in the two groups and from palatal closure to the age of five, the width increased by about 14% in the two groups. The frequency of cross-bite at age five was 64% in group VS and 73% in group LT. The frequency of cross-bite was lower in these two groups than in comparable studies in which palatal closure was made using a Veau-Wardill-Kilner push-back procedure. It was concluded that, up to S years of age, no negative effects on the growth of the alveolar arches or the occlusion were found in patients in whom this type of vomer flap procedure was used.