{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:45:39Z","timestamp":1791895539731,"version":"4.3.4"},"reference-count":88,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"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>Background<\/jats:title>\n                    <jats:p>Despite more than a century of surgical innovation, no single palatoplasty technique has demonstrated consistently superior outcomes across the spectrum of cleft palate phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This review examines the historical evolution of cleft palate reconstruction and contemporary evidence relating operative techniques, technical modifications, and reconstructive adjuncts to oronasal fistula (ONF) and velopharyngeal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative literature search of PubMed\/MEDLINE, Scopus, the Cochrane Library, and Google Scholar (January 1990-March 2026) incorporated original clinical studies, systematic reviews, meta-analyses, and landmark reports, with evidence from primary palatoplasty, symptomatic submucous cleft palate, secondary velopharyngeal surgery, and fistula reconstruction considered according to clinical setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across a heterogeneous evidence base, favorable outcomes were associated with restoration of the levator sling, tension-minimized multilayer closure, preservation of vascularity, adequate tissue recruitment, and adaptation of reconstruction to cleft morphology. The independent contribution of these principles remains uncertain because the evidence is predominantly observational and heterogeneous.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Successive palatoplasty techniques therefore appear to represent different strategies for addressing shared reconstructive constraints rather than competing solutions with uniformly superior outcomes. This updated synthesis integrates established reconstructive principles with contemporary evidence on ONF, velopharyngeal outcomes, cleft morphology, and tissue deficiency to provide an outcome-oriented framework for individualized cleft palate reconstruction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261495240","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:03:02Z","timestamp":1791633782000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cleft Palate Surgery: Evolving Surgical Techniques and Reconstructive Principles for Oronasal Fistula and Velopharyngeal Dysfunction: A Narrative Review"],"prefix":"10.1177","author":[{"given":"Rogelio","family":"Mart\u00ednez-Wagner","sequence":"first","affiliation":[{"name":"Hospital General Dr. Manuel Gea Gonz\u00e1lez"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8372-8922","authenticated-orcid":false,"given":"Kenzo Alejandro","family":"Fukumoto-Inukai","sequence":"additional","affiliation":[{"name":"Hospital General Dr. Manuel Gea Gonz\u00e1lez"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Bejar-Chapa","sequence":"additional","affiliation":[{"name":"Wright State University Boonshoft School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6847-7341","authenticated-orcid":false,"given":"Miguel \u00c1ngel","family":"Dom\u00ednguez-Varela","sequence":"additional","affiliation":[{"name":"Universidad Popular Aut\u00f3noma del Estado de Puebla (UPAEP)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier Andr\u00e9s","family":"Meza-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidad Nacional Aut\u00f3noma de M\u00e9xico (UNAM), Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Heinar","family":"Rodr\u00edguez-Sosa","sequence":"additional","affiliation":[{"name":"Instituto Mexicano del Seguro Social (IMSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6637-7536","authenticated-orcid":false,"given":"Luis Alejandro","family":"Rodr\u00edguez-Corpus","sequence":"additional","affiliation":[{"name":"ISSSTE Regional High Specialty Hospital \u201cCentenario de la Revoluci\u00f3n Mexicana\u201d"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy A.","family":"Hern\u00e1ndez-C\u00e1rdenas","sequence":"additional","affiliation":[{"name":"Universidad Popular Aut\u00f3noma del Estado de Puebla (UPAEP)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3729-217X","authenticated-orcid":false,"given":"Luis Eduardo","family":"Salinas-Ruiz","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, Tecnol\u00f3gico de Monterrey, Monterrey Campus, Monterrey, Nuevo Le\u00f3n, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9178-0195","authenticated-orcid":false,"given":"Jos\u00e9 Emiliano","family":"Gonz\u00e1lez-Flores","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Sciences, Tecnol\u00f3gico de Monterrey, Monterrey Campus, Monterrey, Nuevo Le\u00f3n, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0303-0140","authenticated-orcid":false,"given":"Christopher","family":"De Jes\u00fas-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Benem\u00e9rita Universidad Aut\u00f3noma de Puebla (BUAP)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hernando A.","family":"V\u00e1zquez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Hospital General Dr. Manuel Gea Gonz\u00e1lez"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000006643"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering12080877"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60695-4"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2021.05.008"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrg2933"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2025.12.032"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009555"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199106000-00005"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200111000-00011"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2008.05.048"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2013.2537"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1597\/14-127"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004019"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.4103\/0970-0358.57197"},{"issue":"4","key":"e_1_3_2_16_2","first-page":"335","article-title":"Palatoplasty: Evolution and controversies","volume":"31","author":"Leow AM","year":"2008","unstructured":"Leow AM, Lo LJ. Palatoplasty: Evolution and controversies. Chang Gung Med J. 2008;31(4):335-345.","journal-title":"Chang Gung Med J"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/27325016231201983"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coms.2015.12.004"},{"issue":"4","key":"e_1_3_2_19_2","first-page":"334","article-title":"Velopharyngeal dysfunction: Recommendations for use of nomenclature","volume":"24","author":"Loney RW","year":"1987","unstructured":"Loney RW, Bloem TJ. Velopharyngeal dysfunction: Recommendations for use of nomenclature. Cleft Palate J. 1987;24(4):334-335.","journal-title":"Cleft Palate J"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000010381"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1277712"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1597\/11-125"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619828226"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2024.10.001"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665617752803"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2025.03.052"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000002815"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200011000-00003"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-204.1"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.3109\/02844319409015981"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656251382537"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40136-025-00532-w"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-205.1"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000548"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2005.05.019"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05828-7"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2003_040_0504_doavvm_2.0.co_2"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_1998_035_0095_vfincp_2.3.co_2"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000085599.84458.D2"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181845a21"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1177\/014556131209100320"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2013.01.031"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1071-0949(06)80034-X"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e318199669b"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24200"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.61186\/wjps.12.3.94"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198678060-00002"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000205176.90736.e4"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817703948"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2016.09.019"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000218788.44591.f0"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002181"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2024.04.058"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009385"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.07.044"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000169714.38796.AD"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.4321\/S0376-78922009000100007"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000280"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.07.016"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjx090"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjy077"},{"issue":"3","key":"e_1_3_2_62_2","first-page":"268","article-title":"Primary veloplasty: Long-term results without maxillary deformity. a twenty-five year report","volume":"15","author":"Schweckendiek W","year":"1978","unstructured":"Schweckendiek W, Doz P. Primary veloplasty: Long-term results without maxillary deformity. a twenty-five year report. Cleft Palate J. 1978;15(3):268-274.","journal-title":"Cleft Palate J"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181d5132a"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1080\/02844310600973621"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1597\/11-085"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221140676"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656251405349"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211019616"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000017958"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05976-w"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2003.06.001"},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-013-0198-x"},{"key":"e_1_3_2_73_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000012618"},{"key":"e_1_3_2_74_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656231215141"},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2008.07.020"},{"key":"e_1_3_2_76_2","doi-asserted-by":"publisher","DOI":"10.4103\/0976-237X.152935"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000006151"},{"key":"e_1_3_2_78_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009037"},{"key":"e_1_3_2_79_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656251399789"},{"key":"e_1_3_2_80_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656231206238"},{"key":"e_1_3_2_81_2","doi-asserted-by":"publisher","DOI":"10.1597\/04-034.1"},{"key":"e_1_3_2_82_2","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(85)90239-5"},{"key":"e_1_3_2_83_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2015.03.034"},{"key":"e_1_3_2_84_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.02.026"},{"key":"e_1_3_2_85_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000010267"},{"key":"e_1_3_2_86_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620974562"},{"key":"e_1_3_2_87_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2019.08.018"},{"key":"e_1_3_2_88_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2215162"},{"key":"e_1_3_2_89_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221135288"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261495240","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656261495240","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261495240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:52:28Z","timestamp":1791892348000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656261495240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,10]]},"references-count":88,"alternative-id":["10.1177\/10556656261495240"],"URL":"https:\/\/doi.org\/10.1177\/10556656261495240","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,10]]},"article-number":"10556656261495240"}}