Vomer flap surgery was used prior to 1975 as a surgical treatment for children with cleft palate. In this procedure, the vomer bone was used to reconstruct the palate and cover the cleft.

Vomer flap procedure

The vomer

Vomer

The vomer is one of the unpaired facial bones of the skull. It is located in the midsagittal line, and articulates with the sphenoid, the ethmoid, the left and right palatine bones, and the left and right maxillary bones.-Biology:...

 is a triangle shaped bone that forms the inferior and posterior portion of the nasal septum

Nasal septum

The nasal septum separates the left and right airways in the nose, dividing the two nostrils.It is depressed by the Depressor septi nasi muscle.-Composition:The fleshy external end of the nasal septum is sometimes also called columella....

 (www.emedicine.com/plastic/topic519.htm). A vomer flap is a type of palatoplasty

Palatoplasty

Palatoplasty is a surgical procedure used to correct or reconstruct the palate in a person with a cleft palate. The basic goals of the procedure are to close the abnormal opening between the nose and mouth, to help the patient develop normal speech, and to aid in swallowing, breathing and normal...

 surgery

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 that uses the mucoperiosteal tissue of the vomer to cover a unilateral or bilateral cleft palate. This procedure can be used to reconstruct the nasal or oral surfaces by either raising the vomer or creating a flap. Surgical procedures can be combined according to type of clefting in order to ensure the best outcomes for the patient. Vomer flap surgery involves the suture

Suture (anatomical)

In anatomy, a suture is a fairly rigid joint between two or more hard elements of an animal, with or without significant overlap of the elements....

 line of the vomer bone which is an important site for midface growth. In this case, a suture line refers to boundary between two bony plates which eventually grow together as the child matures.

Vomer flap and mid-facial growth

Over the years, argument has been raised about the possible interference the vomer flap surgery has with midface growth in children. In 1975, defective mid-facial growth found in some patients caused the vomer flap procedure to begin to decline drastically in surgical use (Friede & Johanson, 1977). A debate still exists among researchers and surgeons in regards to the relationship between vomer flap surgery and defective midface growth. Some contemporary surgeons continue to use the vomer flap technique in the nasal lining of patients with cleft palate.

Advantages and disadvantages

Few advantages of the vomer flap procedure include the relative simple execution compared to other palatoplasties, amount of surgery time, and similarity between the vomer tissue and the nasal mucosa. A major disadvantage of the vomer flap surgery is the varying size and visibility of the vomer in different patients. If the vomer is not visible or too small to cover the cleft, the procedure cannot be done. Another disadvantage of the use of the vomer flap in the oral cavity is that the vomer tissue does not aesthetically match the oral mucosa

Oral mucosa

The oral mucosa is the mucous membrane epithelium of the mouth. It can be divided into three categories.*Masticatory mucosa, para-keratinized stratified squamous epithelium, found on the dorsum of the tongue, hard palate and attached gingiva....

. The color and texture of the vomer mucosa matches the nasal mucosa much better than the oral mucosa. Sometimes, patients are displeased and uncomfortable with the visible vomer flap in the oral cavity.