The use of a vomerine flap for palatal lengthening: the modified nagpur technique

Kumar, P.A. Vinod

doi:10.1016/0007-1226(85)90239-5

Cited by 12 publications

(5 citation statements)

References 5 publications

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“…28, 29 Despite the simplicity and safety in creating vomer flaps, sometimes vomerine tissue is either hypoplastic, too superior or not readily available in a partial or submucous clefts. 27, 30 Furthermore, our data shows that Agrawal Type I flaps (nasal mucosa back-cut is not made) do not provide as much robust lateral movement at the posterior nasal spine as it does at the midpalate (Figure 6, 7). …”

Section: Discussionmentioning

confidence: 78%

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

Nguyen

Patel

Parikh

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

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INTRODUCTION This biomechanical study aims to characterize the nasal mucosa during palatoplasty, describing the soft tissue attachments at different zones and quantifying movement following their release. METHODS Palatal nasal mucosa was exposed and divided in the midline in 10 adult cadaver heads. Five consecutive maneuvers were performed: (1) elevation of nasal mucosal off the maxilla; (2) dissection of nasal mucosa from soft palate musculature; (3) separation of nasal mucosa from palatine aponeurosis; (4) release of mucosa at the pterygopalatine junction; (5) mobilization of vomer flaps. The mucosal movements across the midline at the midpalate and posterior nasal spine following each maneuver were measured. RESULTS At the midpalate, maneuvers 1–4 cumulatively provided 3.8 mm (36.9%), 4.9 mm (47.6%), 6.1 mm (59.2%), and 10.3 mm, respectively. Vomer flap (10.5 mm) elevation led to mobility equivalent to that of maneuvers 1–4 (p=0.72). At the posterior nasal spine, cumulative measurements after maneuvers 1–4 were 1.3 mm (10%), 2.4 mm (18.6%), 5.7 mm (44.2%), and 12.9 mm. Here, vomer flaps (6.5 mm) provided less movement (p<0.001). Maneuver 4 yielded the greatest amount of movement of the lateral nasal mucosa at both the midpalate (4.2 mm, 40.8%) and posterior nasal spine (7.2 mm, 55.8%). CONCLUSION At the midpalate, complete release of the lateral nasal mucosa achieves as much movement as the vomer flap. At the hard-soft palate junction, the maneuvers progressively add to the movement of the lateral nasal mucosa. The most powerful step is release of attachments along the posterior aspect of the medial pterygoid.

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Section: Discussionmentioning

confidence: 78%

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

Nguyen

Patel

Parikh

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Another includes the potential increase in the likelihood of anterior hard palate fistula formation following cleft palate repair. [17][18][19][20] Given this context, we describe our experiences using a technique in which the vomerine mucosa is incised, elevated as a superior-based flap and sutured end-to-end fashion to the lateral nasal mucosa. We assess the incidence of postsurgical dehiscence following this procedure and compare the likelihood of anterior palatal fistula formation in this patient group with those who underwent cleft palate repair without prior vomer flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…One notable concern is the risk of vomer flap dehiscence by the time of subsequent palatoplasty. Another includes the potential increase in the likelihood of anterior hard palate fistula formation following cleft palate repair 17–20 . Given this context, we describe our experiences using a technique in which the vomerine mucosa is incised, elevated as a superior-based flap and sutured end-to-end fashion to the lateral nasal mucosa.…”

mentioning

confidence: 99%

Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap

Menville,

Spake,

Soliman

et al. 2024

Journal of Craniofacial Surgery

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Background and Purpose: Anterior palatal reconstruction using vomer flaps has been described during primary cleft lip repair. In this procedure, the mucoperiosteal tissue of the vomer is elevated to reconstruct the nasal mucosa overlying the cleft of the hard palate. Here the authors, evaluate the efficacy of a technique in which a superiorly based vomer flap is sutured to the lateral nasal mucosa. The authors assess vomer flap dehiscence rates and compare the likelihood of fistula development in this cohort to patients who underwent palatoplasty without vomer flap reconstruction. Methods: A retrospective chart review was conducted of all palatoplasties performed by the senior author at an academic institution during a 7-year period. Medical records were reviewed for demographic variables, operative characteristics, and postoperative complications up to 1 year following surgery. Logistic regression analysis was conducted to assess the effects of vomer flap reconstruction on fistula formation, adjusting for age and sex. Results: Fifty-eight (N=58) patients met the inclusion criteria. Of these, 38 patients (control group) underwent cleft palate reconstruction without previous vomer flap placement. The remaining 20 patients underwent cleft lip repair with vomer flap reconstruction before palatoplasty (vomer flap group). When bilateral cases were counted independently, 25 total vomer flap reconstructions were performed. Seventeen of these 25 vomer flap reconstructions (68%) were completely dehisced by the time of cleft palate repair. In the vomer flap group, 3 of the 20 patients (15%) developed fistulas in the anterior hard palate following the subsequent palatoplasty procedure. In the control group, only 1 of the 38 patients (2.6%) developed a fistula in the anterior hard palate. There was no significant association between cohorts and the development of anterior hard palate fistulas [odds ratio=10.88, 95% confidence interval (0.99–297.77) P=0.07], although analysis was limited by low statistical power due to the small sample size. Conclusions: In our patient population, anterior palatal reconstruction using a superiorly based vomer flap technique was associated with complete dehiscence in 68% of cases. Fistula formation in the anterior hard palate was also proportionately higher following initial vomer flap reconstruction (15% versus 2.6%). These results prompted the senior author to adjust his surgical technique to 1 in which the vomer flap overlaps the oral mucosa. While follow-up from these adjusted vomer flap reconstruction cases remains ongoing, early evidence suggests a reduced requirement for surgical revision following implementation of the modified technique.

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Section: History Of Palate Repairsmentioning

confidence: 99%

“…22 Despite conflicting evidence as to whether these flaps result in maxillary growth disturbance, 8,23,24 the Oslo Cleft Palate Team has used vomer flaps in a single-layer closure of cleft palates with great success and minimal facial growth disturbance. 25 In 1931, Veau described the abnormal arrangement of soft palate musculature in the cleft palate patient, which runs longitudinally and parallel to the cleft as opposed to transversely in the normal patient. 10,26 In one of the most important contributions to improving speech, Veau advocated separating soft palate musculature from its insertion on the posterior hard palate to lengthen the soft palate and reduce tension on the mucosal closure.…”

Section: Meaningmentioning

confidence: 99%

Cleft Palate Repair: A History of Techniques and Variations

Yao

Chong

Magee

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Orofacial clefting is a common reconstructive surgical condition that often involves the palate. Cleft palate repair has evolved over three centuries from merely achieving anatomical closure to prioritizing speech development and avoiding midface hypoplasia. Despite centuries of advancements, there is still substantial controversy and variable consensus on technique, timing, and sequence of cleft palate repair procedures. Furthermore, evaluating the success of various techniques is hindered by a lack of universal outcome metrics and difficulty maintaining long-term follow-up. This article presents the current controversies of cleft palate repair and details how the history of cleft palate repair has influenced current techniques commonly used worldwide. Our review highlights the need for a global consortium on cleft care to gather expert opinions on current practices and outcomes and to standardize technique classifications. An understanding of global protocols is crucial in an attempt to standardize technique and timing to achieve anatomical closure with optimal velopharyngeal competence, while also minimizing the occurrence of maxillary hypoplasia and palatal fistulae.

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The use of a vomerine flap for palatal lengthening: the modified nagpur technique

Cited by 12 publications

References 5 publications

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap

Cleft Palate Repair: A History of Techniques and Variations

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