Malformation of the vomer in submucous cleft palate

Background: Several criteria are described in the literature to diagnose a submucous cleft palate. Commonly the differences in the extent of the submu cous cleft will not be as overt as in open clefts, Nevertheless, complete s ubmucous cleft palate may cause imperfect palate-pharyngeal closure so that the affected person needs to undergo speech training and surgical treatmen t, Patients: We investigated 30 patients who underwent palatal repair to co rrect this disorder. They were evaluated according to the Koch's documentat ion system. Results: In all patients an additional malformation of the inne r nose was found: The vomer was not fused with the palatal shelves. There w ere different degrees of severity of this vomerine malformation and they we re not necessarily correlated with the extent of the palatal cleft. Conclus ion: In our opinion, this malformation of the vomer should be seen as a typ ical symptom of classical submucous cleft palate. Discussion is needed on h ow the vomerine malformation should be incorporated into the surgical proce dure, Since we know from septal surgery that a basal septal perforation wil l lead to disturbances of nasal breathing. (C) 2001 European Association fo r Cranio-Maxillofacial Surgery.