UNASSIGNED: Using the bi-nostril 4-hand technique during the endoscopic endonasal approach (EEA) facilitates bimanual microsurgical techniques yet requires resection of the posterior nasal septum. The surgical exposure and degree of maneuverability gained proportionate to the extent of posterior septectomy in the sagittal plane was previously quantified.
UNASSIGNED: We aim to describe our technique of posterior septectomy, and the effect of its extent in the axial plane on surgical access, and instrument maneuverability.
UNASSIGNED: After fracturing the posterosuperior nasal septum, we disarticulate the vomer from the sphenoid rostrum and remove its upper part. The sphenoid rostrum is excised next exposing the clival recess where a suction tip without a side channel is anchored, allowing the assisting surgeon to use an additional instrument in their dominant hand. The vomer is removed down to the level of the floor of the sphenoid sinus.
UNASSIGNED: A wide exposure is achieved in the coronal plane bilaterally at the level of the sphenoid rostrum allowing unobstructed instrument manipulation in the craniocaudal and cross-court trajectories. Furthermore, the floor of the sella is reached through a straight rather than angled trajectory facilitating surgical access, manipulation, and instrument maneuverability. For lateral lesions requiring contralateral access, the assisting surgeon can assist in dissection from the contralateral nostril without changing the position of the endoscope.
UNASSIGNED: Removing the upper vomer improves surgical access, and instrument maneuverability. Simultaneous dissection from both nostrils might be attempted. Caudally extending the posterior septectomy during the EEA allows better exposure and improves surgical access in all planes.

OBJECTIVE: Anterior palatal reconstruction using vomer flaps has been described during primary cleft lip repair. In this procedure, the mucoperiosteal tissue of the vomer is elevated to reconstruct the nasal mucosa overlying the cleft of the hard palate. Here the authors, evaluate the efficacy of a technique in which a superiorly based vomer flap is sutured to the lateral nasal mucosa. The authors assess vomer flap dehiscence rates and compare the likelihood of fistula development in this cohort to patients who underwent palatoplasty without vomer flap reconstruction.
METHODS: A retrospective chart review was conducted of all palatoplasties performed by the senior author at an academic institution during a 7-year period. Medical records were reviewed for demographic variables, operative characteristics, and postoperative complications up to 1 year following surgery. Logistic regression analysis was conducted to assess the effects of vomer flap reconstruction on fistula formation, adjusting for age and sex.
RESULTS: Fifty-eight (N=58) patients met the inclusion criteria. Of these, 38 patients (control group) underwent cleft palate reconstruction without previous vomer flap placement. The remaining 20 patients underwent cleft lip repair with vomer flap reconstruction before palatoplasty (vomer flap group). When bilateral cases were counted independently, 25 total vomer flap reconstructions were performed. Seventeen of these 25 vomer flap reconstructions (68%) were completely dehisced by the time of cleft palate repair. In the vomer flap group, 3 of the 20 patients (15%) developed fistulas in the anterior hard palate following the subsequent palatoplasty procedure. In the control group, only 1 of the 38 patients (2.6%) developed a fistula in the anterior hard palate. There was no significant association between cohorts and the development of anterior hard palate fistulas [odds ratio=10.88, 95% confidence interval (0.99-297.77) P =0.07], although analysis was limited by low statistical power due to the small sample size.
CONCLUSIONS: In our patient population, anterior palatal reconstruction using a superiorly based vomer flap technique was associated with complete dehiscence in 68% of cases. Fistula formation in the anterior hard palate was also proportionately higher following initial vomer flap reconstruction (15% versus 2.6%). These results prompted the senior author to adjust his surgical technique to 1 in which the vomer flap overlaps the oral mucosa. While follow-up from these adjusted vomer flap reconstruction cases remains ongoing, early evidence suggests a reduced requirement for surgical revision following implementation of the modified technique.

Hyperostosis manifests itself and develops differently in taxonomically related species. Radiographic images of individuals belonging to different size classes of Atlantic Moonfish Selene setapinnis and Lookdown Selene vomer were obtained from two different estuarine areas of Rio de Janeiro/Brazil. In S. setapinnis, hyperostosis occurred in 65.22% of the specimens analyzed in three different skeletal regions. All specimens of S. vomer had hyperostosis in four regions. Patterns of occurrence were detected in both species, and the affected regions did not coincide in the same bone region, except for the cleithrum. Hyperostosis in S. setapinnis were observed in high frequencies of seventh dorsal pterygiophore, whereas in specimens of S. vomer this condition was detected to a greater extent in the neural spines of the second abdominal vertebra and first to third caudal vertebrae. The data demonstrated a relationship between the sexual maturity and the occurrence and development of hyperostotic bones in ageing process of individuals. It is the first description of S. vomer with a hyperostosis phenomenon for the species on the Brazilian coast.

The vomer is an important tooth-bearing cranial bone in the lungless salamanders (Caudata: Plethodontidae) that serves different functional roles in aquatic versus terrestrial feeding. Vomerine tooth rows that run parallel with the maxillary teeth are thought to help grasp prey while expelling water from the mouth, while posterior extensions of the tooth row may help terrestrial taxa bring prey down the throat. We hypothesize that these two general morphological types will correlate with the habitat (aquatic vs. terrestrial) of adult salamanders. Alternatively, variation in form may be due to taxonomic effects, such that closely related species will have similar vomer morphology regardless of adult habitat. To test this hypothesis, we examined vomer shape on a set of species of the morphologically diverse tribe Spelerpini, in which two of the five genera (Eurycea and Gyrinophilus) include both aquatic and terrestrial species. Data were collected using micro computed tomography (micro-CT) scans from specimens from the Field Museum of Natural History and the Illinois Natural History Survey; additional data was obtained from public online repositories including Morphosource.org. Two-dimensional geometric morphometric analyses were performed to capture shape variation of both the vomer and the vomerine tooth row. We found clear separation between aquatic and terrestrial taxa, with most of the variation due to differences in the vomerine tooth row. Differences ascribed to habitat use likely correspond to feeding behavior, and the functional role of the vomer in prey processing warrants further investigation in this species-rich salamander family.

BACKGROUND: The current retrospective case-control study evaluates the diagnostic value of screening for a fetal cleft palate by using the ultra-sound-based observation of the \"superimposed-line\" sign appearing at the junction of the vomer and maxilla in the first trimester of pregnancy.
METHODS: Retrospective analyses were performed of ultrasonographic images of nuchal translucency obtained during the first trimester of pregnancy (11-13+6 weeks) from 45 fetuses with a cleft palate later confirmed following parturition or induced labor (cases) and 4,500 normal fetuses confirmed after parturition (controls). Ultrasonographic features of the \"superimposed-line\" sign were observed and recorded, and between-group comparisons were performed.
RESULTS: The \"superimposed-line\" sign was absent in 39 cases (86.67%), including 4 (8.89%) with simple secondary hard palate cleft and 35 (77.78%) with secondary hard palate cleft complicated by a primary cleft palate. The \"superimposed-line\" sign was shown in 6 cases (13.33%), including 2 (4.44%) with a simple secondary soft palate cleft, 1 (2.22%) with a simple secondary bifid uvula, and 3 (6.67%) with a simple primary cleft palate. Among the 4,500 controls, 31 fetuses showed an absence of the \"superimposed-line\" sign (0.69%) and 4,469 showed the \"superimposed-line\" sign (99.31%). The between-group difference was significant (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of the \"superimposed-line\" sign in the first trimester of pregnancy for predicting fetal cleft palate were 86.67% (39/45), 99.31% (4,469/4,500), 55.71% (39/70), and 99.86% (4,469/4,475), respectively.
CONCLUSIONS: The \"superimposed-line\" sign did not appear in fetuses with secondary hard palate cleft and primary cleft palate only when a secondary hard palate cleft is present. The sign appeared in normal fetuses and those with a simple primary cleft palate, simple secondary soft palate cleft, or a simple secondary bifid uvula. Based on these results, we propose that the \"superimposed-line\" sign in the mid-sagittal plane of the fetal face in the first trimester of pregnancy (11-13+6 weeks) is an important tool in screening for fetal cleft palate, especially secondary hard palate cleft.

Since almost all patients with an alveolar cleft have a deviated and thickened vomer bone, the purpose of this study was to investigate the relationship between the vomer shape and the size of the alveolar cleft in patients with unilateral cleft lip and alveolus (CLA). A total of 40 adult patients with unilateral CLA were enrolled, and 40 normal adults without CLA were enrolled as controls. All patients underwent preoperative computed tomography scans and analysis by computer-aided engineering software to obtain the vomer volume (VV), deviated septal angle (DSA), and alveolar cleft volume (ACV). An independent-sample t test or nonparametric test was used to compare the VV and DSA between the unilateral CLA and control groups. The correlation between ACV, VV, and DSA in the unilateral CLA group was assessed using Pearson correlation analysis or Spearman correlation analysis. Vomer volume was significantly higher in patients with CLA (1595.35±48.45 mm3) than in the control group (1043.2±164.976 mm3) (P<0.001), as was DSA (13.099±7.0 versus 3.4398±1.74 degrees) (P<0.001). In the CLA group, VV and DSA were significantly associated with ACV (VV and ACV: r=0.886, P<0.001; DSA and ACV: r=0.543, P<0.001), and VV was significantly correlated with DSA (VV and DSA: r=0.582, P<0.001). In conclusion, the vomer is thicker and more convex in patients with unilateral CLA than in people without, and the vomer angle and degree of volume deviation correlate with alveolar cleft severity.

The cribriform plate and attachment area of the middle turbinate are anatomical structures that may potentially be injured during septoplasty and/or endoscopic sinus surgery. The purpose of this study is to compare the cribriform plate and middle turbinate length dimensions between patients with vomer agenesis (VA) and the control group using paranasal sinus computed tomography (CT). Paranasal sinus CTs performed in our hospital between January 2011 and January 2021 were evaluated and patients with VA were identified. A control group was created from patients who underwent paranasal sinus CT for various reasons during the same date interval. The cribriform plate and middle turbinate lengths were statistically compared between the groups. A total of 10,095 paranasal sinus CTs were evaluated and 54 patients with VA were identified. Seven patients with VA were excluded from the study because their measurements could not be made accurately. Forty-seven VA patients were included in the study group, while 94 patients were included in the control group. There was no statistical difference in cribriform plate dimensions (medial ethmoid roof plate height, cribriform plate height, cribriform plate lateral lamella height and width) between the groups (for all dimensions P >0.05). The middle turbinate length was significantly higher in the VA group (for right and left P =0.020 and 0.011, respectively). These findings theoretically suggest that the risk of cribriform plate injury during septoplasty and/or endoscopic sinus surgery is similar in patients with or without VA.

The present study aims to characterize the ultrastructural roof of the oral cavity roof in juvenile and adult Epinephelus aeneus using SEM. The investigation used 10 roofs of the oral cavity of juvenile and adult stages of age. The results in both age groups showed that the roof had five tooth bands, an upper valve, and a palatine region. The upper lip was divided into the anteriorly median and two lateral parts. The posterior margin of the anterior labial part is not attached to the incisive or canine teeth. The anterior surface of the canine teeth was attached to the transverse part of the upper incisive ridge that was separated from the posterior labial part by a deep groove. The semilunar upper velum showed two surfaces, two borders, and two parts. The median part of the oral surface of the velum carried the extension of the longitudinal part of the upper incisive ridge that had some variation among the two examined age stages. In addition, the median part of the oral surface of the upper velum had two rough areas located laterally on each side of the longitudinal part of the upper incisive ridge. The oral surface had several slightly elevated fungiform papillae with taste buds. The palatine region was divided into the peripheral semilunar part and the wide median part, by palatine teeth and the palatine groove laterally and by vomer teeth anteriorly. The results provided important data for the aquaculture in Egypt in relation to their diet.

A new species Rhynchoconger randalli sp. nov. is described herein on the basis of 2 specimens collected from Paradeep fishing harbor, Odisha, India along the Bay of Bengal from a depth of about 3640 meters. The pentagonal vomerine teeth pattern is unique among all the Rhynchoconger species described to date. The new species is characterized by predorsal vertebrae 78 and preanal vertebrae 2931. The new species closely resembles the recently described Rhynchoconger smithi, but differs in having a larger eye diameter (12.512.9% HL vs. 9.59.7% in R. smithi), smaller interorbital space (13.113.5% HL vs. 15.018.1 in R. smithi), lower dorsal-fin ray count before vent 4447 vs. 5458 in R. smithi, and unique pentagonal vomerine teeth pattern.

BACKGROUND: Patients with alveolar cleft unrepaired suffer from nasal deformities of different magnitude. Bone and cartilage grafts are harvested through several incisions. In this study, we present a method to simultaneously correct nasal deformities and repair alveolar cleft using grafts from the nasal septum.
METHODS: All 6 patients with unilateral cleft lip and palate have alveolar cleft unrepaired combined with nasal deformity. Computed tomography scans and 3-dimensional-printed models of vomer and ethmoid bone were used for the purpose of preoperative design and for assessing the magnitude of deformity. Grafts of bone and cartilage from deviated septum were harvested by septoplasty through which dorsum deviation was corrected. Bone grafts from vomer and ethmoid were then fixed to the prepared alveolar cleft to repair the defect and elevate the alar base. Septal cartilage was adjusted into different shapes of grafts and deformities of nasal tip, nostrils, and columella were then corrected by rhinoplasty to restore the symmetry of the nose.
RESULTS: Symmetry of nostrils was improved. The height of alar base on the cleft side was elevated to the level close to the noncleft side. Deviation of the septum, nasal dorsum, and columella was corrected. Projection of the nasal tip was adjusted to facial midline. Midface aesthetics was generally improved.
CONCLUSIONS: Application of septal grafts reduce the number of incisions. One-stage repair of alveolar cleft and nasal deformities, with the aid of digital design, improves the postoperative experience and the general outcome of the surgery.