Impact of Vomer Flap on Nutritional Status in Infants With Cleft Lip and Palate: A Multicenter Retrospective Cohort Study

Objective To determine the effect of early hard palate closure by means of a Vomer flap (VF) on the nutritional status of children with cleft lip and palate. Design Multicenter retrospective cohort study. Setting Three referral centers for oral clefts. Patients, Participants Nonsyndromic children with UCLP or BCLP. Interventions: Early hard palate closure with a VF at cheiloplasty around 3 months versus isolated cheiloplasty, both followed by palatoplasty around 9 to 10 months. Main Outcome Measure(s) Anthropometric measures (weight and height) and related weight-for-age and height-for-age Z-scores at the time of cheiloplasty and palatoplasty. Results Between 2012 and 2024, 122 children with UCLP or BCLP underwent cleft repair surgery. Median age at cheiloplasty was 111 (99-126) days and 304 (284-342) at palatoplasty. In 60% of them (n = 73), a VF was performed simultaneously with cheiloplasty. Weight increase between cheiloplasty and palatoplasty was slightly more for the VF group compared to the control group by 0.24 kg (SE = 0.15, P = .13). No height difference was measured between the groups ( P = .80). Z-score variation between cheiloplasty and palatoplasty was significantly different for all study groups, indicating a strong normalization of the growth curve after cheiloplasty ( P < .001). Conclusions Early hard palate closure using a VF may favor growth in children with cleft lip and palate. The deviation from the normative growth curve of infants decreases significantly between cheiloplasty and palatoplasty, regardless of whether a VF was performed.