{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:14:41Z","timestamp":1791994481382,"version":"4.4.0"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Oro-nasal fistula formation remains one of the most common complications following primary palatoplasty, while the influence of surgical technique on fistula incidence and characteristics remains controversial. This study aimed to compare the occurrence and features of oro-nasal fistulas after two primary palatal repair techniques. Methods: A retrospective comparative analysis was conducted in patients undergoing one-stage primary palatoplasty using either closed intravelar palatoplasty or a modified Veau\u2013Wardill\u2013Kilner pushback technique. Oro-nasal fistulas were evaluated according to presence, size, anatomical location, and functional impact. Secondary corrective procedures, including fistula repair and pharyngoplasty, were also analyzed. Results: Oro-nasal fistula formation was significantly associated with the surgical technique. Closed intravelar palatoplasty demonstrated a significantly lower fistula rate compared with the modified Veau\u2013Wardill\u2013Kilner technique. Cleft type and syndromic status were not independently associated with fistula development. Rates of secondary corrective procedures and pharyngoplasty were significantly lower in the intravelar group. Conclusions: Surgical technique plays a decisive role in oro-nasal fistula development after primary palatoplasty. Muscle-oriented repair with limited incisions is associated with reduced fistula formation and a lower need for secondary surgical interventions.<\/jats:p>","DOI":"10.3390\/jcm15082825","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T09:49:44Z","timestamp":1775641784000},"page":"2825","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgical Technique and Oro-Nasal Fistula Formation After Primary Palatoplasty: A Comparative Study of Closed Intravelar and Modified Veau\u2013Wardill\u2013Kilner Techniques"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2951-1946","authenticated-orcid":false,"given":"Kostadin","family":"Gigov","sequence":"first","affiliation":[{"name":"Section of Plastic Reconstructive and Aesthetic Surgery and Thermal Trauma, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, \u201cSt. George\u201d University Hospital Plovdiv, Medical University of Plovdiv, \u201cPeshtersko shausse Blvd 66\u201d, 4002 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5206-5992","authenticated-orcid":false,"given":"Ivan","family":"Ginev","sequence":"additional","affiliation":[{"name":"Section of Plastic Reconstructive and Aesthetic Surgery and Thermal Trauma, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, \u201cSt. George\u201d University Hospital Plovdiv, Medical University of Plovdiv, \u201cPeshtersko shausse Blvd 66\u201d, 4002 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3340-4979","authenticated-orcid":false,"given":"Petra","family":"Kavradjieva","sequence":"additional","affiliation":[{"name":"Section of Plastic Reconstructive and Aesthetic Surgery and Thermal Trauma, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, \u201cSt. George\u201d University Hospital Plovdiv, Medical University of Plovdiv, \u201cPeshtersko shausse Blvd 66\u201d, 4002 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8679-9674","authenticated-orcid":false,"given":"Ivaylo","family":"Minev","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Emergency and Intensive Care Medicine, Clinic of Anaesthesiology and Intensive Care, \u201cSt. George\u201d University Hospital Plovdiv, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6566-1542","authenticated-orcid":false,"given":"Mariya","family":"Miteva","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, \u201cSt. George\u201d University Hospital Plovdiv, Medical University of Plovdiv, \u201cVassil Aprilov\u201d 15A, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60695-4","article-title":"Cleft lip and palate","volume":"374","author":"Mossey","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1502877","DOI":"10.3389\/fped.2025.1502877","article-title":"Burden of orofacial clefts from 1990-2021 at global, regional, and national levels","volume":"13","author":"Ma","year":"2025","journal-title":"Front Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1597\/10-178","article-title":"Genetics of nonsyndromic orofacial clefts","volume":"49","author":"Rahimov","year":"2012","journal-title":"Cleft Palate Craniofac. 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