A follow-up study of cleft children treated with vomer flap as part of a three-stage soft tissue surgical procedure. Facial morphology and dental occlusion.

The development of the face and jaws in cleft patients, treated with a three-stage surgical procedure including a single layer vomer flap, was studied by analysing cephalometric radiographs and dental casts. The material consisted of 13 patients with complete bilateral cleft lip and palate and 50 cases with complete unilateral cleft lip and palate, operated on 1964--1970. At the follow-up the average patient in both cleft categories demonstrated a maxillary retrognathia and in the unilateral cleft sample also a facial skeletal profile straighter than normal, though not as pronounced as we had found in cases where the vomer flap procedure was accompanied by bone grafting. However, the mean profile for the bilateral as well as the unilateral cleft group was straighter than reported for patients subjected to neither vomer flap nor bone grafting. The occlusal findings confirmed the maxillary growth retardation and similarly placed the present patients at a level between the results of the other two types of surgical regimes. As a side-effect cleft-bridging bone was formed in some part of the hard palate in every second case, though without importance for facial development. In an effort to reduce the restricted mid-facial growth found in the present patients, we have changed our surgical technique and since 1975 excluded the use of vomer flaps.