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.