Surgical Technique and Oro-Nasal Fistula Formation After Primary Palatoplasty: A Comparative Study of Closed Intravelar and Modified Veau–Wardill–Kilner Techniques

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–Wardill–Kilner 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–Wardill–Kilner 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.