Surgical Outcomes and Challenges in Primary Palatoplasty among Adults: A Retrospective Cohort Study of 395 Patients.

ObjectiveTo evaluate surgical outcomes and challenges associated with primary palatoplasty in adults.DesignRetrospective cohort studySettingLahore, Pakistan, from 2015 to 2024.Patients/ParticipantsA total of 395 adult patients (≥18 years) with unrepaired overt cleft palate ± cleft lip undergoing primary palatoplasty (mean age = 21.6 years, 55.6% male, 44.4% female).InterventionsPrimary palatoplasty was performed using von Langenbeck, Bardach 2-flap, or midline incision-only techniques. Modifications for wide clefts and adjunctive pharyngeal flaps were used when indicated.Main Outcome MeasuresPostoperative fistula formation and speech outcomesResultsBilateral incomplete cleft palate (Veau II) was the most common phenotype (35.9%) encountered. Postoperative fistula formation occurred in 16.9% of patients, most commonly at the hard-soft palate junction. Increasing age was independently associated with fistula formation (adjusted odds ratio 1.05; 95% confidence interval (CI) 1.001-1.09; P = 0.04). Composite speech scores improved significantly from 14.6 ± 0.75 to 12.3 ± 1.41 (95% CI 2.15-2.45; P < 0.001), representing modest speech improvement.ConclusionPrimary palatoplasty in adults remains technically challenging but can provide modest improvements in speech outcomes and functional communication.