{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:04:54Z","timestamp":1789671894026,"version":"4.0.1"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate surgical outcomes and challenges associated with primary palatoplasty in adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Lahore, Pakistan, from 2015 to 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>A total of 395 adult patients (\u226518 years) with unrepaired overt cleft palate \u00b1 cleft lip undergoing primary palatoplasty (mean age\u2009=\u200921.6 years, 55.6% male, 44.4% female).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Primary 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Postoperative fistula formation and speech outcomes<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Bilateral 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;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.04). Composite speech scores improved significantly from 14.6\u2009\u00b1\u20090.75 to 12.3\u2009\u00b1\u20091.41 (95% CI 2.15-2.45;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.001), representing modest speech improvement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary palatoplasty in adults remains technically challenging but can provide modest improvements in speech outcomes and functional communication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261489252","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T14:27:27Z","timestamp":1789482447000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Outcomes and Challenges in Primary Palatoplasty among Adults: A Retrospective Cohort Study of 395 Patients"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4851-7865","authenticated-orcid":false,"given":"Muhammad","family":"Daiem","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, CLAPP Hospital, Lahore, Pakistan"},{"name":"Department of Plastic Surgery, Operation Smile"},{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghulam Qadir","family":"Fayyaz","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, CLAPP Hospital, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohaib","family":"Irfan","sequence":"additional","affiliation":[{"name":"Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Mustehsan","family":"Bashir","sequence":"additional","affiliation":[{"name":"King Edward Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9028-4392","authenticated-orcid":false,"given":"Haya","family":"Bajwa","sequence":"additional","affiliation":[{"name":"Al-Faisal University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvee","family":"Turk","sequence":"additional","affiliation":[{"name":"University of Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-5490","authenticated-orcid":false,"given":"David","family":"Chong","sequence":"additional","affiliation":[{"name":"Royal Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-9610","authenticated-orcid":false,"given":"Nivaldo","family":"Alonso","sequence":"additional","affiliation":[{"name":"University of Sao Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7930-3394","authenticated-orcid":false,"given":"Jordan P.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Nicklaus Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabila","family":"Talat","sequence":"additional","affiliation":[{"name":"The Children's Hospital, University of Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romaisa","family":"Shamim","sequence":"additional","affiliation":[{"name":"Services Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall G.","family":"Miles","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Vyas","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Children's Hospital of California, Irvine, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1570-6263","authenticated-orcid":false,"given":"Jitske","family":"Nolte","sequence":"additional","affiliation":[{"name":"Amsterdam UMC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3587-7489","authenticated-orcid":false,"given":"Corstiaan","family":"Breugem","sequence":"additional","affiliation":[{"name":"Amsterdam UMC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215162"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200008000-00026"},{"key":"e_1_3_3_4_2","volume-title":"StatPearls [Internet]","author":"Phalke N","year":"2025","unstructured":"Phalke N, Goldman JJ. 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