D75. A Comparison of Vomer Flap Palatoplasty Techniques on Fistula Repair in Bilateral Cleft Lip and Palate: A Single Center 25-year Experience

Abstract

PURPOSE: In bilateral cleft lip and palate (BCLP) patients, vomer flaps can facilitate the closure of larger defects by adding width to the nasal layer. This study aims to assess the effect of vomer flaps on velopharyngeal insufficiency (VPI). METHODS: A retrospective review of patients diagnosed with cleft lip and/or palate(CL/P)who underwent palatoplasty at an urban academic children’s hospital between 1997-2022 was completed. Surgical technique, postoperative management, and surgical VPI rates were collected. Statistical analysis was performed with RStudio 4.2.1. RESULTS: Upon review, 1,552 patients were identified with CL/P, of which 191 (12.3%) had BCLP with a VPI rate of 18.3%. Among patients with BCLP, 88.3% underwent palatoplasty with vomer flap. There were lower rates of postoperative VPI requiring surgery in the vomer flap cohort than in patients without vomer flap (13.2% vs. 57.1%, p=0.012), however patients with vomer flaps were more frequently managed with speech therapy alone (47.2% vs. 28.6%, p=0.034). Logistic regression demonstrates that vomer flaps were the only significant contributor to increased rates of speech surgery. Overall follow-up time was 8.9±4.5 years. CONCLUSION: These results associate vomer flaps with decreased rates of surgical VPI and higher rates of speech interventions. This suggests VPI following palatoplasty augmented with vomer flap may be less severe. Use of vomer flaps to restore nasal mucosa continuity and reconstruct the velum should be considered to minimize risk of severe VPI requiring surgery.