Does vomer or palatal flap have less adverse effect on maxillary growth in cleft patients? – No good evidence available


Cleft lip (CL) and cleft palate (CP) are common birth defects that affect around 1 in 700 children born.  Surgery to repair the palate is thought to affect maxillary growth. The vomer flap is assumed to cause less scarring and therefore have less impact on growth. The aim of this review was to investigate the effect of the vomer flap versus the palatal flap on facial growth.

PubMed and Medline were searched for papers that reported quantitative data on facial growth after both vomer and palatal flaps for repair of the hard palate. Only English language studies were included.  Two reviewers carried out selection and data abstraction independently, study quality was also assessed.

  • 6 studies were included. All were retrospective 5 were cross sectional, 1 longitudinal.
  • A qualitative summary of the findings is presented.
  • Outcomes assessed in 4 studies were dentofacial morphology after vomer or palatal flap, maxillary dental arch in 1 study, and dental arch relations in 2 studies. The quality of the methods used in 3 studies was poor.

The authors concluded

Contradictory results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the vomer flap technique has more or less of an adverse effect on maxillary growth than the palatal flap. Further well-designed, well-controlled, and long-term studies particularly of the vomer flap (2-stage) and palatal flap (von Langenbeck or two-flap, 1-stage) are needed.


While the there are minor differences between PubMed and Medline these are essentially difference front-end tools to the same database so it can be argued that this is not a systematic review. Restricting the search to English may also limit the number of potential studies identified. This means that a wider search using languages other than English may have identified some additional studies.  However , a Cochrane review ( Guo et al 2011) of secondary bone grafting for children with clefts also only identified two trials for that procedure despite searching more databases and in all languages.  As the authors note a multi-centre trail is underway, the Scandcleft Clinical Trial. which may provide some more robust evidence.


Lee Y-H, Liao Y-F. Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review. Br J Oral Maxillofac Surg (2013) article in press

Guo J, Li C, Zhang Q, Wu G, Deacon SA, Chen J, Hu H, Zou S, Ye Q. Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD008050. DOI: 10.1002/14651858.CD008050.pub2.


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