Timing, Surgical Techniques, and Functional Outcomes in Primary Cleft Palate Repair: A Focused Review of Clinical Evidence.

A structured literature review was conducted across PubMed, Scopus, and Web of Science using predefined search terms related to cleft palate, palatoplasty, timing, and velopharyngeal insufficiency (VPI). The aim was to evaluate the impact of surgical timing and operative techniques on functional outcomes following primary cleft palate repair, with a focus on velopharyngeal function. Randomized controlled trials (RCTs) and observational cohort studies reporting speech-related outcomes were included. Considerable heterogeneity was identified in surgical timing, techniques, and outcome definitions. Most observational studies did not show a statistically significant association between timing and speech outcomes. Anatomical factors, particularly cleft width and subtype, demonstrated a stronger correlation with postoperative outcomes. Current evidence does not support a universally optimal timing for primary palatal repair. Functional outcomes appear to be influenced by multiple factors beyond timing, including surgical technique and patient-specific characteristics. Standardized outcome measures and multicenter studies are needed to improve comparability and guide clinical decision-making.