The Anatomy of the Vomer

Located in the center of the nasal cavity, the vomer is a thin, unpaired bone of the face and skull (cranium). This small, trapezoidal bone serves as part of the nasal septum, which is the middle wall of the nasal respiratory cavity. It attaches to important bones of the skull, as well as the band of cartilage that help shape the nose and face.

Since it is located in the nose, the vomer can be damaged due to nasal fracture or injury. Its anatomy and function can be impacted by other conditions as well, including deviated septum (an irregular shape of the nasal septum), cleft palate, and tumor growth.

Anatomy

Structure and Location

The smallest bone of the skull, the vomer is thin and flat; if you viewed it from the side, it would be shaped like a trapezoid. Sitting perpendicular to the front of the face within the nasal cavity, it is arranged vertically in the skull.

As part of the nasal septum, which divides the respiratory cavity in half, it sits on the midline of the viscerocranium, which is a term for the 14 bones that make up the face.

While the two faces of the vomer make up the walls of the septum, its four borders articulate with (attach to) several important bones and structures of the skull and face. Here’s a quick breakdown:

• Upper (superior) border: The thickest of the vomer’s edges, the upper border has ridges that articulate with the body and the projections (processes) of the sphenoid bone, a central, unpaired bone of the skull. In addition, it borders on the sphenoidal processes of the palatine bones, two L-shaped bones that help make up the lower border of the cranium.   
• Lower (inferior) border: The lower edge of this bone articulates with the medial nasal crest, a ridged formed by the maxilla, which forms the upper jaw and separates the oral and nasal cavities and the palatine bones.  
• Front (anterior) border: The longest of the vomer’s edges, the upper half of the anterior border meets the perpendicular plate of the ethmoid bone, a complex, central bone of the cranium. The lower half, in turn, is attached to the nasal septal cartilage, which helps make up the septum.    
• Rear (posterior) border: The back side of this bone is concave, and a little shorter and thicker than the anterior border. It doesn’t articulate with any bones and instead separates the posterior choanae, which are basically the rear projections of the nostrils

Anatomical Variations

As with other bones of the face and cranium, congenital abnormalities or deformations can impact the vomer. These include:

• Congenital deviated septum is when the nasal septum is off-center, leading to mismatches in the size of the left and right passages. While this is relatively common—occurring in about 20% of newborns­—and often asymptomatic, in some cases it can lead to blockages, snoring, nosebleeds, and sinus infections, among other symptoms.
• Cleft palate is a birth defect that causes an opening or split in the tissue of the roof of the mouth. In some cases, the vomer may be partially or completely fused to the palate. This condition leads to difficulty feeding and speaking.
• Vomer agenesis is the absence of this bone at birth. This very rare defect occurs on its own or in some cleft palate cases and is largely asymptomatic.

Function

The vomer’s main job is to help support the structure of the nasal passages and face. Running as it does down the middle of the viscerocranium, this bone, along with a band of nasal cartilage, skin, and blood vessels, divides the nasal respiratory cavity in two.

Ensuring smooth passage of air through the respiratory cavity is not only an aspect of breathing, smelling, and tasting, it is also important for speech and articulation.

Associated Conditions

The conditions most often associated with the vomer are:

• Deviated septum: This condition can certainly affect the position and health of the vomer itself. While it can be congenital, it may also arise due to injury or trauma to the nose or face. In addition, it can result due to excessive ingestion of powdered drugs, such as cocaine, or methamphetamine.
• Nasal septal fracture: Occurring most often due to inter-personal violence, sporting injury, or automobile accidents, severe fractures of the nose will also impact the vomer. Depending on the scope of damage, this can significantly affect breathing, while causing pain, swelling, and other symptoms.
• Myxoma: Tumors that arise in the sinuses or face, called myxomas, can, in very rare cases, also form on the vomer. These may or may not be cancerous and can interrupt breathing, increase pressure, or cause other issues.

Rehabilitation

For many disorders of the sinus and vomer—especially deviated septum or cleft palate—surgery is the preferred treatment; however, it’s an option typically reserved after other means of managing these conditions haven’t worked out. These treatment options may be considered:

• Medications: While taking medications won’t correct the underlying problem caused by a deviated septum, it can help manage symptoms. Options include corticosteroid sprays, such as Rhinocort (budesonide), and Nasacort (triamcinolone), nasal rinses, and over-the-counter decongestant drugs like Afrin (oxymetazoline), Sudafed (phenylephrine), and more.
• Septoplasty: A standard, minimally-invasive, and outpatient treatment for deviated septum, septoplasty involves accessing the nasal cartilage and the bone, and using specialized tools to reshape these. The nose itself, is not broken, and parts may be removed to make the repair. 
• Cleft palate repair: Once infants are old enough—usually at about six to 12 months—surgery will be performed to correct a cleft palate. Sometimes an additional surgery, which involves grafting bone to the palate, is needed; this is done when children are between 8 and 12 years old.
• Closed reduction: For nasal fractures, doctors will typically advise you wait a couple of days to see if swelling and other symptoms have reduced before evaluation.