Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap.

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.

"Septoplasty" Performed at Primary Cleft Rhinoplasty: A Systematic Review of Techniques and Call for Accurate Terminology.

OBJECTIVE: Primary cleft nasal repair can include septal reconstruction. We hypothesize that primary cleft septoplasty and adult septoplasty have fundamental differences that render these procedures as distinct surgical entities. DESIGN: Systematic review of the PubMed, Cochrane, and Embase databases performed on pediatric cleft and general adult septoplasty techniques through December 2021. (PROSPERO ID CRD42022295763). MAIN OUTCOME MEASURES: Collected data included information on septal dissection, septal detachment, and management of the bony and cartilaginous septum. RESULTS: Twenty-eight pediatric cleft septoplasty and 229 adult septoplasty studies were included. Dissection in primary cleft septoplasty was limited to the anterocaudal septum, while secondary cleft septoplasty and adult septoplasty techniques entailed wide exposures of the cartilaginous septum with or without exposure of the perpendicular plate of the ethmoid. In primary cleft septoplasty, detachment of the septum was mostly limited to the nasal spine and anterior base of the cartilaginous septum, while secondary cleft septoplasty and adult septoplasty included detachment from the vomer, and ethmoid. In the few reports of cartilage excision during primary cleft septoplasty, removal was limited to the anterior inferior border of the septum, while secondary cleft septoplasty and adult septoplasty included excision of the cartilaginous and bony septum. CONCLUSION: Primary cleft septoplasty is distinct from septoplasty performed on facially mature patients. More specifically, septal dissection and detachment are limited to the anterior caudal area during primary lip repair, with rare removal of cartilage or bone. Given these differences, the authors suggest the term "septal reset" to describe septoplasty performed during primary cleft nasal repair.

A Rare Case of Glial Choristoma Arising from the Vomer in Association with Cleft Palate.

Heterotopic neuroglial tissue represents normal glial tissue in an abnormal location distant from the central nervous system. It is a rare congenital condition and the majority of these lesions are diagnosed at birth or early childhood. We report a rare case scenario of a growth arising from the vomer associated with cleft palate. The origin of a glial choristoma from the midline of the nasal cavity in association with a cleft palate has not been reported in the literature. Complete surgical excision was performed prior to palatoplasty with no postoperative complications or evidence of recurrence.

Premaxillary Setback With Posterior Vomerine Ostectomy and Complete Bilateral Cleft Lip Repair: Report of a Case With Challenging Anatomy.

Congenital clefts of the lip and/or palate are among the most common craniofacial malformations. Patients with bilateral cleft of the lip often present with projected premaxilla. Premaxillary setback with a vomerine ostectomy posterior to the vomero-premaxillary suture, bilateral cleft lip repair, bilateral gingivoperiosteoplasties, and primary cleft lip rhinoplasty are achieved in a single-stage surgery that provides a valuable alternative to patients, especially in the outreach settings. In this article, we present a case report of a patient born with a bilateral cleft of the lip and a protruded premaxilla. He had collapsed secondary palatine shelves requiring intraoperative manual expansion to ensure access to the vomer bone.

One-Stage Repair of Alveolar Cleft and Nasal Deformities Using Grafts From Nasal Septum: Application of Vomer, Ethmoid, and Septal Cartilage.

BACKGROUND: Patients with alveolar cleft unrepaired suffer from nasal deformities of different magnitude. Bone and cartilage grafts are harvested through several incisions. In this study, we present a method to simultaneously correct nasal deformities and repair alveolar cleft using grafts from the nasal septum. PATIENTS AND METHODS: All 6 patients with unilateral cleft lip and palate have alveolar cleft unrepaired combined with nasal deformity. Computed tomography scans and 3-dimensional-printed models of vomer and ethmoid bone were used for the purpose of preoperative design and for assessing the magnitude of deformity. Grafts of bone and cartilage from deviated septum were harvested by septoplasty through which dorsum deviation was corrected. Bone grafts from vomer and ethmoid were then fixed to the prepared alveolar cleft to repair the defect and elevate the alar base. Septal cartilage was adjusted into different shapes of grafts and deformities of nasal tip, nostrils, and columella were then corrected by rhinoplasty to restore the symmetry of the nose. RESULTS: Symmetry of nostrils was improved. The height of alar base on the cleft side was elevated to the level close to the noncleft side. Deviation of the septum, nasal dorsum, and columella was corrected. Projection of the nasal tip was adjusted to facial midline. Midface aesthetics was generally improved. CONCLUSION: Application of septal grafts reduce the number of incisions. One-stage repair of alveolar cleft and nasal deformities, with the aid of digital design, improves the postoperative experience and the general outcome of the surgery.

Speech of Patients With Unilateral Complete Cleft Lip and Palate: Comparison of Three Different Surgical Protocols for Primary Repair.

BACKGROUND AND AIMS: Between 1997 and 2014, 3 protocols have been used in out cleft unit for primary repair of unilateral cleft lip and palate. During the Scandcleft randomized controlled trial closing the soft palate and lip at 4 months and the hard palate at 12 months (Protocol 1) was compared with closing the entire palate at 12 months (Protocol 2). Protocol 3 comprises closure of the lip and hard palate with a vomer flap at 4 months and the soft palate at 10 months. The purpose of this study was to compare subsequent velopharyngeal competence at age of 3 and 5 years. PATIENTS AND METHODS: The study consisted of 160 non-syndromatic patients with a unilateral cleft lip and palate. Protocol 3 was retrospectively compared with Protocols 1 and 2 within the previously published Scandcleft study. RESULTS: At 3 years of age, normal or borderline competent velopharyngeal function was found in 68% of patients in Protocol 1, 74% of patients in Protocol 2, and 72% of patients in Protocol 3. At 5 years of age, the corresponding figures were 84%, 82%, and 92%. 21% of patients in Protocol 1, 4% in Protocol 2, and 23% in Protocol 3 had palatal reoperations before the age of 5 years. CONCLUSION: No significant differences emerged in velopharyngeal competence at age 3 years between the 3 protocols. Palatal reoperations were performed earlier in patient groups 1 and 3, explaining the difference in the velopharyngeal competence rate at the 5-year time-point.

Visualisation of the vomerovaginal canal during endonasal transpterygoid approaches and CT imaging diagnosis.

The vomerovaginal canal (VVC) and palatovaginal canal (PVC) are two canals that open forward to the posterior wall of the pterygopalatine fossa (PPF). Although the anatomy and computed tomography (CT) appearances of the PVC have been well studied, the VVC has been rarely reported, especially in endoscopic examinations. Some studies have even failed to distinguish the PVC from the VVC on CT images. The purpose of this study was to demonstrate the anatomy of the VVC on endoscopy and reveal its differences from the PVC, and to analyse the relative positions of the VVC, PVC, and pterygoid canal on CT images. Ten dry skull bases were studied to observe the structures involved in the formation of the VVC. Dissection of four cadaveric heads was performed to demonstrate the anatomy of the VVC on endoscopy. Coronal CT image analysis in 70 patients was conducted to evaluate the distances and relative positions between the VVC, PVC, and pterygoid canal. The PVC and VVC were also compared on axial CT images. The osteological study showed the top wall of the VVC was the antero-inferior wall of the sphenoid sinus. The VVC may be a helpful landmark in endoscopic endonasal transpterygoid approaches. Steps and discrimination in the dissections of the VVC and PVC were described. The interval between the PVC and VVC could be observed on both coronal and axial CT images. The coronal CT images of patients showed differences in the positions and distances among the three canals at both the anterior and posterior apertures of the PVC. The VVC can be easily mistaken for the PVC if its existence is not suspected. The anatomical morphologies and trajectories of the VVC and PVC differed on both nasal endoscopy and CT. The existence of the VVC should be considered during surgery and CT diagnosis within this area.

Suturing a Vomer Flap to the Hard Palate Through a Hole When the Nasal Lining is Not Available.

The nasal lining by suturing a vomer flap onto the bony ridge of the cleft through a hole was repaired.A 16-month-old girl had an incomplete bilateral posterior cleft palate. While incising the periosteum and elevating the nasal mucosa from the cleft edge of the right side, the mucosa was sheared and a buttonhole was made, and as a result, the nasal lining could not be coapted. A vomer flap to close the nasal lining was applied. On the left side, the nasal mucosa from the cleft margin was sutured to the vomer flap. On the right side, where no nasal lining was available, 2 holes were drilled 5 mm lateral to each bony cleft margin, and the vomer flap was sutured to the palate with 4-0 vicryl through the holes. The elevated bilateral mucoperiosteal flaps were brought together to the midline and sutured to the anterior triangular flap in a V-Y pushback fashion.This method could be used to cover the nasal lining when nasal mucosa is not available.

Vomer Flap: A Golden Tool for the Treatment of Cleft Palate.

Despite the lack of consensus regarding the treatment of labio-palatal clefts, each treatment protocol is the expression of an individual perspective that accumulates the experience of each multidisciplinary group, which all pursue the same goal: to achieve adequate language development with the lowest possible impact on facial growth. To achieve this, a management scheme has been developed, this exploits vomer flaps for the closure of palatal clefts and limits dissections in the palatine segments. Modifications are presented in the design and dissection of vomer flaps, so as to use the largest amount of mucosal tissue available, thus facilitating closure of the different clefts, particularly in Veau Group III clefts.

Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap.

OBJECTIVE: To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap. DESIGN: Retrospective. SETTING: Single center. PATIENTS: Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon. INTERVENTIONS: Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique. MAIN OUTCOME MEASURE(S): Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility. RESULTS: The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal-subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile. CONCLUSIONS: Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Maxillary Growth in Cleft Lip and Palate Patients, With and Without Vomerine Flap Closure of the Hard Palate at the Time of Lip Repair: A Retrospective Analysis of Prospectively Collected Nonrandomized Data, With 10-Year Cephalometric Outcomes.

OBJECTIVE: To assess the midterm effect on maxillary growth of vomerine flap (VF) closure of the hard palate, at the time of lip repair. DESIGN: A retrospective analysis of prospectively collected nonrandomized data. INTERVENTIONS: Consecutive participants with a unilateral cleft lip and palate (UCLP) were operated on, at 3 months of age, by the same surgeon. They were divided into 2 groups, those who had a VF and those who did not (non-VF). SETTING: Participants were treated at 2 hospitals in the United Kingdom. PARTICIPANTS: Twenty-eight participants in the VF group and 24 participants in the non-VF group attended follow-up at 10 years of age. MAIN OUTCOME MEASURES: Standardized lateral cephalometric radiographs were taken at 10 years. Following tracing and digitization, parameters to assess the maxillary growth were analyzed. RESULTS: No statistically significant differences were found in the anterior-posterior or vertical skeletal cephalometric parameters. CONCLUSIONS: The results of this study support the statement that VF repair does not significantly affect maxillary growth in patients with a UCLP, when assessed cephalometrically at 10 years of age. It should be noted that at this age, growth is not yet complete.

Descriptive Analysis of Sphenovomerine Suture and Its Importance in Neurosurgery.

PURPOSE: Articulation of rostrum of sphenoid bone with alae of vomer forms a schindylesis type of joint. The circumference of this joint, called sphenovomerine suture (SVS), is very important in establishing a reliable surgical field in the endoscopic transsphenoidal pituitary surgery. Because of its vital role in endoscopic transsphenoidal pituitary surgery, this radio-anatomical study was designed to establish the morphological properties of SVS. METHODS: In this study, the authors examined SVS in 235 patients (121 females and 114 males) on the computed tomography images of the paranasal sinus and made 4 measurements to describe SVS. RESULTS: The mean distance between superior margin of the upper labial philtrum and top of SVS was 6.66 ±â€Š0.43 cm for females and 7.44 ±â€Š0.54 cm for males. The distance between the top of SVS and dorsum sellae was 3.08 ±â€Š0.33 cm for females and 3.19 ±â€Š0.32 cm for males, the alae of vomer angle in the upper surface was 74.22 ±â€Š20.06° for females and 74.23 ±â€Š19.68° for males. The distance between the most lateral points of 2 alae of vomer was 0.99 ±â€Š0.17 and 1.01 ±â€Š0.19 cm for females and males, respectively. CONCLUSIONS: For an easy and successful operation, removal of the SVS is very important as it will provide a better view of the sellar base and make the management of the surgical instruments easier in the wider safe surgical field thus created.

Maxillary V-4: Four implant treatment for maxillary atrophy with dental implants fixed apically at the vomer-nasal crest, lateral pyriform rim, and zygoma for immediate function. Report on 44 patients followed from 1 to 3 years.

STATEMENT OF PROBLEM: The V-4 implant placement technique is important for restoring patients with maxillary atrophy, but little has been documented on the outcomes of these treatments. PURPOSE: The purpose of this study was to evaluate the outcome of immediate function after 1 year when implants were placed without vertical bone augmentation in Cawood-Howell Classes IV-VI maxillary atrophy (Class C-D by the "all-on-four" site classification) with the nasal crest, lateral pyriform rim, and sometimes the zygoma for apical implant fixation. MATERIAL AND METHODS: Function of implants that had been immediately loaded were studied retrospectively after 1 year in 44 patients from 2 different clinics. For each patient studied, 2 angled implants were placed in the midline in the nasal crest/vomer area, and typically, 2 implants were engaged apically in the lateral pyriform rim bilaterally. All 4 of the implants used were angled toward the midline in a V formation, termed "V-4" implant placement. Insertion torque, anterior-posterior spread, implant diameter, implant length, and posterior cantilever were recorded. Implant survival and bone stability were assessed after 1 year. When the lateral pyriform was highly deficient (Class D), zygomatic implants were used posteriorly. RESULTS: A total of 179 implants were placed in 44 patients followed for 1 to 3 years. Six implants were lost, all in 1 patient. Anterior-posterior spread averaged 16 mm, with an average cantilever of 7.5 mm. Except for the lost implant sites, bone levels were stable throughout treatment for all patients. CONCLUSIONS: The use of 4 implants angled toward the midline, including 2 implants placed into a V-shaped point at the nasal crest and 2 implants placed into an M-shaped point at the pyriform rim bilaterally, showed good stability after 1 year despite gross absence of bone mass as a result of severe maxillary atrophy. The V-4 placement pattern is important for patients with deficient bone mass between the sinus and nasal cavities. In Class D situations where lateral nasal rim bone mass is nearly absent, zygomatic implants can be used.

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery.

BACKGROUND: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero-premaxillary suture. MATERIAL AND METHODS: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. RESULTS: The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid's bow, as well as good scars. Conclusions: To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don't know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are required.

Nasolabial appearance after two palatoplasty types in cleft lip and palate.

BACKGROUND: Facial appearance is important for normal psychosocial development in children with cleft lip and palate (CLP). There is conflicting evidence on how deficient maxillary growth may affect nasolabial esthetics. METHODS: We retrospectively investigated nasolabial appearance in two groups, the Langenback (35 children; mean age 11.1 years; range: 7.9-13.6) and Vomerplasty (58 children; mean age 10.8 years; range: 7.8-14), who received unilateral CLP surgery by the same surgeon. The hard palate repair technique differed between the two groups. In the Langenback group, palatal bone on the non-cleft side only was left denuded, inducing scar formation and inhibiting maxillary growth. In the Vomerplasty group, a vomerplasty with tight closure of the soft tissues on the palate was applied. Thirteen lay judges rated nasolabial esthetics on photographs using a modified Asher-McDade's index. RESULTS: Nasolabial esthetics in both groups was comparable (p > 0.1 for each nasolabial component). Inferior view was judged as the least esthetic component and demonstrated mean scores 3.18 (SD = 0.63) and 3.13 (SD = 0.47) in the Langenback and Vomerplasty groups, respectively. Mean scores for other components were from 2.52 (SD = 0.63) to 2.81 (SD = 0.62). Regression analysis showed that vomerplasty is related with slight improvement in the nasal profile only (coefficient B = -0.287; p = 0.043; R(2 ) = 0.096). CONCLUSIONS: This study demonstrates that the use of vomerplasty instead of the Langenbeck technique is weakly associated with the nasolabial appearance among pre-adolescent patients with UCLP.

Carpentering in septorhinoplasty: a novel technique to straighten the deviated nasal septum.

Septal deviation presents a considerable challenge in septorhinoplasty because it leads to functional and esthetic problems. This deformity may displace the nasal tip, disturb nasal valve patency, and affect the final outcomes of septorhinoplasty. This report describes an innovative technique that can be used in patients with C-shaped deviation of the septum in a cephalocaudal direction. Because the procedure is similar to carpentering, it was named a "carpenter spreader graft." In this technique, the deviated dorsal cartilage is separated and displaced to a new straightened position.

Does contribution of extended vomer flap to palatoplasty affects speech results.

Development of normal speech is the primary goal of successful palatoplasty. The purpose of this study was to determine the importance of the contribution of vomer flap to palatoplasty procedure for speech function. Eighty-one children who underwent 2 flap palatoplasty procedures for cleft palate repair between 2002 and 2010 were retrospectively reviewed in 3 groups. Group 1 underwent palatoplasty without contribution of vomer flap. Group 2 underwent palatoplasty with standard dissection of vomer flap, whereas group 3 underwent palatoplasty with extended dissection of vomer flap. Speech function of the patients was evaluated using objective assessment tools such as nasopharyngoscopy and nasometer. Eighty-one children who underwent 2 flap palatoplasty were included in this study. The mean age at palatoplasty was 10.17 months, and mean length of follow-up was 72.33 months. For most syllables, patients repaired using extended vomer flap demonstrated lower nasalance scores. Nasopharyngoscopic examination revealed velopharyngeal motility in 24 patients (80%) in group 1 and in 20 (83.3%) and 23 (85.2%) patients in groups 2 and 3, respectively (P = 0.930). In velopharyngeal closure, there were only 5 patients (18.5%) in group 3, whereas there were 6 patients (25.0%) for group 2 and 10 patients (33.3%) for group 1 with no closure (P = 0.311). Although most optimum results were observed in the group with extended dissection of the vomer flap, contribution of the extended vomer flap to the repair of the soft palate did not lead to significantly better speech results.

Early effect of vomerine flap closure of the hard palate at the time of lip repair on the alveolar gap and other maxillary dimensions.

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.

[Cleft palate surgery with ENT-pathology correction].

The article presents the cases of cleft palate surgical treatment with simultaneous intervention in ENT organs (bypass of the tympanic cavity, segmental or total adenotomy, etc.) with the restoration of vomer anatomy and hard palate reconstruction by means of super-elastic low-profile nickel titanium implant. The article describes the advantages of the method in comparison with the conventional ones.

Reconstruction of congenital vomeral bone defect using the outer table of the skull.

A congenital nasal septal defect involving vomeral bone is a rare nasal anomaly, and few reconstructed cases have been reported. Reconstruction of the nasal septum using the outer table of skull to allow the use of glasses was performed. The patient's postoperative course was uneventful, and the patient was discharged on the tenth postoperative day. A transferred bone remains and shows no deviation to the right or left in the ninth postoperative month. The tubercle of the nasal part remains, and the patient is satisfied with the cosmetic result 9 months postoperatively. The timing of the operation and the surgical procedure are discussed.