Vomer flap for hard palate repair is related to favorable maxillary growth in unilateral cleft lip and palate.
OBJECTIVE
Vomer flap repair is assumed to improve maxillary growth because of reduced scarring in growth-sensitive areas of the palate. Our aim was to evaluate whether facial growth in patients with unilateral cleft lip and palate was significantly affected by the technique of hard palate repair (vomer flap versus two-flap).


METHODS
For this retrospective longitudinal study, we analyzed 334 cephalometric radiographs from 95 patients with nonsyndromic complete unilateral cleft lip and palate who underwent hard palate repair by two different techniques (vomer flap versus two-flap). Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. The associations among facial morphology at age 20, facial growth rate, and technique of hard palate repair were assessed using generalized estimating equation analysis.


RESULTS
The hard palate repair technique significantly influenced protrusion of the maxilla (SNA: β = -3.5°, 95 % CI = -5.2-1.7; p = 0.001) and the anteroposterior jaw relation (ANB: β = -4.2°, 95 % CI = -6.4-1.9; p = 0.001; Wits: β = -5.7 mm, 95 % CI = -9.6-1.2; p = 0.01) at age 20, and their growth rates (SNA p = 0.001, ANB p < 0.01, and Wits p = 0.02).


CONCLUSIONS
The results suggest that in patients with unilateral cleft lip and palate, vomer flap repair has a smaller adverse effect than two-flap on growth of the maxilla. This effect on maxillary growth is on the anteroposterior development of the alveolar maxilla and is progressive with age. We now perform hard palate closure with vomer flap followed by soft palate closure using Furlow palatoplasty.


CONCLUSIONS
These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.
Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. yfliao0125@yahoo.co.uk.|Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. yfliao0125@yahoo.co.uk.|College of Medicine, Chang Gung University, Taoyuan, Taiwan. yfliao0125@yahoo.co.uk.|Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road Gueishan Township, Taoyuan, 333, Taiwan. yfliao0125@yahoo.co.uk.
Yu-Fang
YF
Liao
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ying-Hsin
YH
Lee
Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Ruby
R
Wang
Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chiung-Shing
CS
Huang
Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Philip Kuo-Ting
PK
Chen
Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Lun-Jou
LJ
Lo
Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Yu-Ray
YR
Chen
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000473:pathology / Q000601:surgery*; D002972:Cleft Palate / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000254:growth & development*; D021362:Palate, Hard / Q000601:surgery*; D055815:Young Adult