BackgroundAcellular Dermal Matrix graft is usually used to repair fistulas following a cleft palate and has had positive results. But its use for primary palatoplasty has been less studied. Our aim was to compare the usefulness of using Acellular Dermal Matrix transplantation for primary palatoplasty with intravelar veloplasty in contrast to its lack of useMaterials and methodsA total of 72 children (6 months to 6 years old) with cleft palate were included in the study. The case-control prospective observations were conducted. A group underwent primary palatoplasty with intravelar veloplasty using Acellular Dermal Matrix and the control group had the same surgery without using Acellular Dermal Matrix. Patients were monitored for fistula formation, post-operative infection, and ulcers.ResultsNo post-surgical infection and wound opening was seen in any group. In the recipients of Acellular Dermal Matrix and control group three and six fistula was reported in which patients had soft and hard palate involvement and the cleft with length greater than 15 mm.ConclusionsConsidering the double incidence of fistulas in the control group compared to the ADM recipient, it seems that the use of ADM can be effective in reducing the incidence of fistulas. Since fistula is one of the complications of primary palatoplasty surgery and leads to secondary surgeries, the use of ADM can be helpful.