Early Effect of Vomerine Flap Closure of the Hard Palate at the Time of Lip Repair on the Alveolar Gap and Other Maxillary Dimensions

Maggiulli, Federica M.D., Surgical Fellow, Norman Hay, BDS, MSc, F. Orth RCS.
Mars, Michael BDS., D.Orth. Ph.D
Worrell, Emma Dip.Sci (Dent.Tech.), M.I.M.P.T., Ph.D
Green, James Dip.Sci (Dent.Tech.), L.B.I.D.S.T.
Sommerlad, Brian MB, BS, FRCSEng

Dr. Maggiulli is Surgical Fellow, Plastic Surgeon, Plastic and Maxillofacial Surgery Department, The Bambino Gesù Children's Hospital, Rome, Italy. Dr. Hay is Consultant Orthodontist, Dr. Mars is Consultant Orthodontist, Dr. Green is Maxillofacial Prosthetist, and Mr. Sommerlad is Consultant Plastic Surgeon, Great Ormond Street Hospital, London, United Kingdom, and St. Andrew's Centre, Broomfield Hospital, Chelmsford, Essex, United Kingdom. Dr. Worrell is Consultant Maxillofacial Prosthetist, Great Ormond Street Hospital, London, United Kingdom.

Presented at the 11th International Congress of Cleft Lip and Palate and Related Craniofacial Anomalies, Fortaleza, Brazil, September 10-13, 2009, and at the poster session of the 67th Annual Meeting of the American Cleft Plate-Craniofacial Association, Fort Worth, Texas, March 15-20, 2010.

Submitted November 2011; Accepted November 2012.

Address correspondence to: Dr. F. Maggiulli, Plastic Surgical Fellow at Plastic and Maxillofacial Surgery Department, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome Italy.

E-mail: [email protected].

The Cleft Palate-Craniofacial Journal 51(1):p 43-48, January 2014. | DOI: 10.1597/11-297

Objective:

Comparison of the effects of vomerine flap (VF) closure of the hard palate at the time of lip repair with non-closure of the hard palate in subjects with unilateral cleft lip and palate (UCLP).

Design:

Retrospective, single-blinded, cohort study.

Setting:

Study model sets of 40 consecutive, non-syndromic, infants with complete UCLP operated on between 1988 and 1998.

Patients:

All subjects were operated on by a single consultant plastic surgeon immediately before and after the unit's change of protocol (1993), when VF closure of the hard palate was incorporated at the time of lip repair. Subjects were divided into two groups: VF (n = 18) and non-VF (n = 22), which acted as a control group. Each subject had maxillary impressions taken before lip repair at 3 months (VF mean age = 11.7 weeks; non-VF mean age = 13.4 weeks) and before palate repair at 6 months (VF mean age = 22.8 weeks; non-VF mean age = 24.0 weeks).

Main Outcome Measures:

Seven predetermined landmarks and four maxillary dimensions were computed following single-blinded analysis using a reflex microscope.

Results:

Repeatability tests showed good measurement precision. The operator measurement errors were 0.00018 mm in a horizontal plane (X and Y) and 0.00028 in the vertical plane (Z). The VF group showed significant changes in the alveolar cleft width. There were no statistically significant changes in any arch-form variable between the VF and non-VF groups.

Conclusion:

The decrease of alveolar arch gap width at palate repair (6 months) in the VF group was significantly more than the decrease observed in the non-VF group, and there was no significant decrease in the, anterior and posterior arch width or anteroposterior length of the hard palate in the VF group compared with the non-VF group.