3D evaluation of the effects of traumatic surgical techniques on Vomer bone volume and morphology in the treatment of lip and palate clefts

BACKGROUND: Cleft lip/palate (CLP) deformity is the most common congenital facial anomaly. In this study, it was aimed to evaluate the changes in volume and shape of Vomer bone after CLP repair surgery.
METHODS: The images of a total of 30 patients aged between 9 and 12 years which were recorded with computed tomography were retrospectively analyzed. The patients were divided into three groups: No syndrome, operated for unilateral CLP group (n=10), no syndrome, operated for bilateral CLP group (n=10), and control group (n=10) with no syndrome, no operation history, or no lip/palate deformities. Data of the patients were transferred to a software program and a new three-dimensional image was created for the Vomer.
RESULTS: There was no statistically significant difference in the Sella-Nasion lengths, Vomer base lengths, and Vomer vertical lengths among the three groups. However, the Vomer bone volume of the patients with bilateral CLP was found to be statistically significantly higher than the control group.
CONCLUSION: We can conclude that more bone formation may be observed due to the periosteal reaction following bilateral Vomer flap elevation or during maxillary growth, tension on the palatal flap may be increased new bone formation by pulling the bilateral Vomer flap if it is elevated and sutured palatal mucoperiosteal flap in the early period. Our findings have led us to the conclusion that size and volume of the Vomer bone can be significantly affected by environmental factors. According to the functional matrix theory, scar tissue formation and lack of Vomer-maxilla fusion cannot stimulate the further development of the anterior cranial bones, leading to shorter anterior cranial base.

Dudak ve damak yarýklarýnýn tedavisinde kullanýlan travmatik cerrahi tekniklerinin Vomer kemik hacmi ve morfolojisi üzerine etkilerinin 3D olarak deðerlendirilmesi

AMAÇ: Dudak damak yarýðý (DDY), deformitesi en sýk görülen konjenital yüz anomalisidir. Bu çalýþmada yarýk dudak/damak onarým cerrahisi sonrasý vomer kemiði deðiþikliklerinin hacmi ve þekli deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Yaþlarý, 9–12 arasýnda olan toplam 30 hastanýn bilgisayarlý tomografi (BT) görüntüleri geriye dönük olarak incelendi. Bireyler, üç gruba ayrýldý 1) herhangi bir sendromu olmayýp tek taraflý CLP (n=10) için ameliyat edilen grup, herhangi bir sendromu olmayan opere edilmiþ çift taraflý CLP grubu (n=10) ve herhangi bir sendromu ve dudak damak yarýðý deformitesi olmayan kontrol grubu (n=10). Hastalarýn verileri, üç boyutlu bir yazýlým programýna aktarýlarak, Vomer kemiðinin üç boyutlu görüntüsü üzerinde metrik ve hacimsel ölçüm yapýldý.
BULGULAR: Üç grup arasýnda Sella-Nasion uzunluðu, Vomer taban uzunluðu ve Vomer dikey uzunluðu arasýnda istatistiksel olarak anlamlý bir fark yoktu. Ancak çift taraflý CLP’li hastalarýn Vomer kemik hacimi, kontrol grubundan istatistiksel olarak önemli derecede yüksek bulundu.
TARTIÞMA: Çift taraflý Vomer flebinin elevasyonunu takiben periost reaksiyonu oluþurken, erken dönemde damak mukoperiosteal flebe dikilince maksilla büyürken vomeri de sürükleyerek daha fazla kemik oluþumuna neden olabilir. Bulgularýmýz, Vomer kemiðinin boyutunun ve hacminin çevresel faktörlerden önemli ölçüde etkilenebileceði sonucuna varmamýzý saðladý. Fonksiyonel matriks teorisine göre skar dokusu oluþumu ve Vomer-maksilla füzyonunun yetersizliði, ön kraniyal kemiklerin geliþiminin yetersiz olmasý, ön kafa kaidesinin daha kýsa kalmasýna neden olabilmektedir.