ABSTRACT
Velopharyngeal sphincter reconstruction and oronasal fistula during cleft palat repair is still a matter of challenge to pediatric and ENT surgeons. To improve results of surgical treatment of cleft palate and secondary velopharyngeal incompetence a simple modified procedure for palatoplasty and velopharyngeal sphincter reconstruction is made.: Thirty three patients with cleft palate[26 primary and 7 recurrent were corrected by this procedure from April 2005 to April 2010.In this procedure the well mobilized palatal muscles allow good repair for the nasal layer, and its medial rotation give push back and increases the length of well functioning soft palate, with narrowing of the velopharyngeal isthmus. The modifications in the nasal layer repair prevent the oronasal fistula and elongate the nasal posterior which reduces the velopharyngeal isthmus. All corrected patients showed good results, with no recurrence, no post-operative fistulae, with accepted phonation pattern for all Arabic alphabetic and no nasal regurgitation need for further pharyngoplasty