Is a Vomer Flap at Primary Palatoplasty Associated With the Formation of a Bony Palatal Bridge?

ObjectiveThe presence of a bony palatal bridge at the time of alveolar cleft grafting has been shown to improve bone graft outcomes. The purpose of this study was to determine if there is an association between palate repair with a vomer flap and formation of a bony palatal bridge in patients with cleft lip and palate.DesignSingle-institution, retrospective cohort study.SettingTertiary children's hospital in an urban setting.PatientsPatients with cleft lip and palate who underwent primary palatoplasty between 1996 and 2017 and had cone beam computed tomography (CBCT) prior to alveolar bone grafting.InterventionsPrimary palatoplasty with or without vomer flap.Main Outcomes Measure(s)The presence of a bony palatal bridge on pre-alveolar bone graft CBCT.ResultsOf 238 patients who underwent primary palatoplasty at a mean age of 10.0 months, 225 (94.5%) had a vomer flap. Bony palatal bridge formation was observed in 128 patients (53.8%) on pre-graft CBCT scans. Among patients with a bony palatal bridge, 121 (94.5%) had a vomer flap at primary palatoplasty. No significant association was found between use of a vomer flap and bony palatal bridge formation (p = 0.996). Secondary analyses demonstrated no significant associations with age at primary palatoplasty (p = 0.157), history of pre-surgical orthopedics (p = 0.777), syndromic status (p = 0.101), or cleft type (p = 0.408).ConclusionsThis study demonstrated that the use of a vomer flap during primary cleft palate repair was not associated with the formation of a bony palatal bridge. Further studies will focus on other factors that may contribute to the etiology of bony palatal bridge formation.