ObjectiveDevelop and apply novel data visualization techniques to analyze longitudinal cleft surgical care and to identify patterns in treatment timing and procedural burden across 2 cleft teams.DesignRetrospective cohort study of operative data using novel data visualization methods.SettingTwo cleft teams in the United States.Patients and ParticipantsPatients with cleft lip and/or palate with operative clinical encounters between 2018 and 2023. Team A had 228 patients and team B had 355.InterventionsVisualization of primary cleft-related surgical procedures which were cleft lip and palate repair, fistula repair, alveolar bone grafting, correction of velopharyngeal insufficiency, orthognathic surgery, and rhinoplasty.Main Outcome Measure(s)Visual interpretation of surgical timing, frequency, volume, and distribution using novel timelines, stacked-bar charts, and ridgeplots.ResultsTimeline visualizations clarified procedural sequencing and highlighted variation in treatment timing by team and phenotype but were too dense for interpretation for a large volume of patients. Stacked-bar charts illustrated procedural volume but lacked temporal insight. Ridgeplots demonstrated both timing of procedures and aggregate team volume.ConclusionsIndividual patient timelines can effectively depict deviation from "ideal" care protocols, but aggregate data may be best depicted by a ridgeplot. These tools may support quality improvement initiatives by transforming raw data into actionable insights and enhancing multidisciplinary team reflection.

ObjectiveTo identify morphosyntax and lexical ability predictors in children with repaired cleft palate (CP) with or without cleft lip (CP ± L).DesignProspective longitudinal cohort study.SettingMultisite institutional.ParticipantsEighty-eight toddlers with nonsyndromic CP ± L.ProceduresParticipants' parents completed the MacArthur-Bates Communicative Development Inventories (CDI) Words and Gestures and background information questionnaires at 16-month visits. They also recorded 2 to 4 hours of their child's vocalizations/words using Language Environmental Analysis (LENA™) recorders. Recordings were analyzed for the number and type of consonants produced. At 24-month visits, parents completed the CDI Words and Sentences.Main Outcome MeasuresMean utterance length of the child's three longest utterances (M3L) and expressive vocabulary reported on the CDI Words and Sentences.ResultsThe results showed significant associations for vocabulary and M3L at 24 months with maternal education level (MEL), total consonants, stop consonants, CDI words produced, and CDI words understood at 16 months. Additionally, vocabulary and the area deprivation index were significantly correlated. Age at palatoplasty, cleft Veau classification, Pierre Robin Sequence, preterm birth, and family history of speech-language delay/disorder were not significantly associated with M3L or vocabulary. Linear regression indicated that MEL, stop consonant production, and CDI words understood at 16 months significantly predicted expressive vocabulary and M3L at 24 months.ConclusionStop consonant production remained a significant predictor of expressive vocabulary and morphosyntax skills, after controlling for other factors. These findings suggest early intervention targeting stop production should promote expressive language skills. Children's stop consonant inventory should be closely monitored following palatoplasty.

ObjectiveTo evaluate maxillary growth differences when buccal fat pad graft (BFP) is utilized during primary cleft palate repair, and to evaluate the need for later surgical revision of the BFP due to non-eruption of maxillary permanent molars.DesignRetrospective cohort study.SettingInstitutional hospital and clinic.PatientsPatients with CP ± L who underwent primary palatoplasty with or without BFP.InterventionsMaxillary measurements of pre-orthodontic dental models.Main outcome measureMaxillary dimensions, disruption to maxillary permanent molar eruption.ResultsPatients treated with BFP exhibited a tendency toward an increased maxillary posterior width and a more favorable maxillomandibular posterior transverse relationship (P = 0.069 and 0.072, respectively). A similar percentage of patients required maxillary expansion between the non-BFP and BFP-treated group (P = 0.103). Secondary surgical revision was recommended for 70.6% of BFPs placed due to inhibition of eruption of the maxillary permanent molars. 33.3% of BFP revisions were not combined with any other surgical procedure during the general anesthesia event.ConclusionThe use of BFP adjunctive flap during primary palatoplasty likely allows for increased transverse growth of the posterior maxilla during childhood and likely reduces the maxillomandibular posterior arch width discrepancy. However, the use of this graft does not reduce the proportion of patients who require orthodontic maxillary expansion. Patients may experience disruption of maxillary permanent molar eruption, and 70.6% of BFPs placed require secondary surgical intervention under general anesthesia to reposition the flap in late childhood.

ObjectiveTo systematically review advances in surgical techniques for secondary cleft palate repair, emphasizing their impact on velopharyngeal function, speech outcomes, and the methodological validity of speech assessments used in published studies.DesignFollowing PRISMA 2021 guidelines, six electronic databases were searched for articles from January 2012 to February 2025 using MeSH terms related to secondary cleft palate repair, velopharyngeal insufficiency, palatoplasty, and speech outcomes. Eligible studies included clinical reports with ≥10 patients undergoing secondary repair. Data on surgical methods, outcomes, and complications were extracted and qualitatively synthesized due to heterogeneity across studies.SettingAll published clinical studies evaluating secondary cleft palate repair outcomes.Patients/ParticipantsIndividuals presenting with residual velopharyngeal insufficiency, recurrent fistula, or speech dysfunction following primary palatoplasty.Main Outcome MeasuresSpeech resonance and intelligibility, velopharyngeal closure rate, fistula recurrence, donor-site morbidity, and obstructive sleep apnea risk.ResultsFourteen studies met the inclusion criteria. Palate-based re-repair with Furlow double-opposing Z-plasty and buccal myomucosal flaps improved resonance and closure in small to moderate gaps. Pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but increased the risk of airway obstruction. However, most studies lacked validated speech protocols or controlled for articulatory errors and fistula effects, limiting confidence in the interpretation of outcomes.ConclusionsWhile secondary repairs often improve resonance and velopharyngeal competence, evidence remains constrained by heterogeneity and non-validated assessment methods. Future multicenter research integrating standardized, speech pathologist-verified protocols is essential to establish evidence-based algorithms for secondary cleft palate repair.

ObjectiveThe current study aimed to evaluate the speech outcome of primary Furlow palatoplasty with buccal myomucosal flap (FPBF) versus two flap palatoplasty (TFP) in patients with cleft palate.Materials and methodsThirty patients with cleft palate were included in the current study. Fifteen patients received the primary FPBF as the surgical palatal repair technique, while the other 15 patients received the primary TFP as their cleft palate repair. All surgeries were done by a single surgeon at the age of 9–12 months. Speech assessment was done at the age of 4–8 years, including the amount of hypernasality, speech intelligibility, compensatory misarticulation, and nasopharyngoscopy VP valve competence.ResultsStatistically significant improvements were detected in the 4 assessment methods while comparing primary FPBF versus the TFP groups’ scores.ConclusionPrimary FPBF might be able to improve the speech outcome in comparison to TFP in patients with cleft palate. Clinical significance Primary FPBF improves the amount of hypernasality, speech intelligibility, compensatory misarticulation, and nasopharyngoscopy VP valve competence. Accordingly, it limits the need for further VP repair surgeries. Trial registration Clinicaltrials.gov (NCT06856330).Supplementary InformationThe online version contains supplementary material available at 10.1007/s00784-025-06695-6.

ObjectiveTo investigate operative experiences and perspectives of surgeons presented with cleft lip (CL) and/or palate (CP) in children with life-limiting and terminal illnesses.DesignSurvey study.SettingElectronic.Patients, ParticipantsAmerican Cleft Palate Craniofacial Association surgeon members.InterventionsNone.Main Outcome MeasuresProportion of surgeons who performed cleft lip and/or palate (CL/P) repair, likelihood to operate again, and factors impacting operative decision.ResultsResponse rate was 20.5% (121/589) including 113 surgeons treating CL/P across plastic surgery (63.7%), otolaryngology (23.9%), and oral and maxillofacial surgery (12.4%). More completed CL than CP repairs (59.3% vs 21.2%) for patients with example conditions of holoprosencephaly, cardiac abnormalities, trisomy 13, and trisomy 18. Leading CL repair motivations were "parent/caregiver request" (89.6%, 60/67), "appearance" (62.7%, 42/67), and "feeding" (28.4%, 19/67). Leading CP repair motivations were "parent/caregiver request" (66.7%, 16/24), "feeding" (62.5%, 15/24), and "communication" (54.2%, 13/24). Surgeons who had not attempted CL repair described lacking opportunity (34.8%, 16/46) or unfavorable risk-benefit ratios (37.0%, 17/46) as reasons. A greater proportion of those who had not attempted CP repair cited unfavorable risk-benefit ratios (59.6%, 53/89) versus lacking opportunity (21/89, 23.6%). 100% and 95.8% who repaired CL and CP endorsed they would again.ConclusionsSurgeons more commonly repaired CL than CP in children with life-limiting and terminal illnesses. Nearly all would perform these surgeries again. Respondents who did not repair CP often stated risks outweighed benefits. Studies exploring outcomes of CL/P repair in patients with life limiting and terminal illnesses are scarce. More data are needed to help guide these difficult decisions.

To develop a method for reconstructing the distal soft palate in cleft closure using reproducible anatomical landmarks. A total of 110 patients with congenital cleft lip and/or palate were included in two cohorts (53 and 57 patients). Each cohort was divided into three groups based on the surgical technique: Group 1 - anatomical landmark-based technique; Group 2 - Ivanov-Ageeva technique; Group 3 - traditional methods. Outcomes were assessed using a custom aesthetic scoring scale, parental satisfaction questionnaires, and measurements of operative time and intraoperative blood loss. The landmark-based technique provided the best and most consistent aesthetic results. Surgeon-assigned aesthetic scores were 14/6±0.4 (Group 1), 12.3±0.9 (Group 2), and 8.8±1.2 (Group 3), p < 0.001. Operative time was shorter in Group 1 (155.1±29/4 min) than in Group 2 (197.5±33.8 min), p < 0.001. Parental satisfaction was also highest in Group 1 (4.77±0.44), p < 0.001. Incorporating anatomical landmarks in cleft palate repair standardizes the surgical approach and significantly improves aesthetic and functional outcomes.

This study aimed to compare the efficacy and safety of midazolam oral solution in children undergoing cleft lip and palate repair surgery. Children aged 4 months to 14 years old were randomly assigned to 3 groups: group A, group B, and group C. Group A received 0.3mg/kg midazolam oral solution, group B received 0.5mg/kg midazolam oral solution, and group C received normal saline 30 min before entering the operating room. The Ramsay Sedation Score (RSS), Mask Acceptance Score (MAS), and Pediatric Anesthesia Emergence Delirium (PAED) scale at the post-anesthesia care unit (PACU) were recorded. The secondary outcomes were the postoperative side effects during the PACU stay and the perioperative hemodynamic fluctuation. Of 75 patients enrolled, 74 completed the study. Compared with group C, groups A and B demonstrated increased RSS, reduced MAS, and PAED scale scores (P < 0.05). Compared with group A, group B exhibited lower PAED scores, longer awakening times, and PACU stays (P < 0.05). No significant differences were observed among the 3 groups in perioperative hemodynamic fluctuation, FLACC scores, extubation times, or postoperative side effects (P > 0.05). These findings supported that midazolam oral solution provides effective preoperative sedation in children undergoing cleft lip and palate repair, improves mask acceptance, and reduces the incidence of emergence agitation. While the 0.5mg/kg dose provides better mask acceptance, adequate sedation, and less emergence agitation than 0.3mg/kg dose, it also requires a slightly longer recovery time and duration of staying PACU.

IntroductionThe vomer flap is a versatile surgical technique used in cleft palate repair, primarily to reconstruct the nasal layer of the hard palate. Its implementation has gained renewed interest due to its anatomical advantages and potential for reducing postoperative complications, especially oronasal fistulas.ObjectiveThis narrative review aims to evaluate the historical evolution, technical variations, clinical indications, outcomes, and limitations of the vomer flap in both unilateral and bilateral cleft palate repair.MethodsA systematic literature search was conducted across PubMed, Embase, and Cochrane Library databases, including studies published from 1981 to April 2024. Articles were selected based on relevance to vomer flap use in cleft surgery, focusing on surgical outcomes, functional results, complication rates, and long-term effects on maxillary growth.ResultsThree main techniques were identified for unilateral clefts: cephalically based, caudally based, and open-book vomer flaps. For bilateral clefts, cephalically based and open-book configurations demonstrated superior anatomical adaptation and lower fistula rates compared to caudally based flaps. The vomer flap is particularly advantageous in early repairs and wide clefts, with evidence suggesting a minimal adverse effect on maxillary development. However, high variability in technique and outcome reporting limits comparability.ConclusionThe vomer flap remains a valuable tool in cleft palate repair, offering a balance between surgical efficacy and preservation of growth potential. It's appropriate application, based on cleft morphology and surgical objectives, can enhance functional and aesthetic outcomes. Further prospective studies are needed to standardize technique and validate long-term benefits.

This explorative study aimed to investigate the potential association between preoperative ultrasound-guided suprazygomatic maxillary nerve block (SMNB) and reduced perioperative opioid consumption in pediatric patients undergoing primary cleft palate repair. The authors hypothesized that SMNB would decrease the need for opioid analgesics for perioperative pain management. A retrospective cohort study. The control group underwent primary cleft palate repair without SMNB, while the intervention group received bilateral SMNB preoperatively. This study was conducted at the Department of Plastic Surgery, Maastricht University Medical Centre MosaKids Children's Hospital, a tertiary care institution. Twenty pediatric patients (below 2y) were included. Ten received SMNB, and 10 historical controls were selected from an existing database. The SMNB group received bilateral ultrasound-guided 0.15mL/kg of 0.25% bupivacaine with adrenaline (1:200,000) under general anesthesia. The control group did not receive a regional nerve block. The primary outcome was perioperative opioid consumption (tramadol and morphine). Secondary outcomes included additional analgesic use (paracetamol, NSAIDs) and length of hospital stay. Morphine consumption was significantly lower in the SMNB group (median 0.00mg versus 0.75mg, P=0.02), while tramadol use showed no significant difference (P=0.23). Secondary outcomes, including additional analgesic use and hospital stay, were not significantly different. Preoperative ultrasound-guided SMNB may be associated with reduced perioperative opioid consumption in pediatric primary cleft palate surgery. Larger, preferably randomized trials are needed to confirm its role in multimodal analgesia protocols.

ObjectiveTo investigate whether the use of buccal fat pad flap during cleft palate repair reduces the risk of post-operative palatal fistula formation.DesignRetrospective analysis of cleft palate repairs undertaken by a single surgeon over the period 2013-2025.SettingTertiary care institution in London.PatientsTwo hundred and seventy-seven patients (146 female, 131 male) who underwent cleft palate repair between 2013 and 2025 were included in the study. One hundred and seventy-three patients had an isolated cleft palate, 78 patients had a unilateral cleft lip and palate, and 26 patients had a bilateral cleft lip and palate. The range of cleft width treated was 3-22 mm. The standard surgical technique employed a Sommerlad style intravelar veloplasty with von Langenbeck releases where necessary.InterventionsThe utilization of pedicled buccal fat pad flap in primary cleft palate repairs.Main Outcome Measure(s)Development of post-operative palatal fistula.ResultsAmong 277 patients, 21 (7.6%) patients developed a post-operative fistula, most commonly in Zone IV (52%). The fistula rate was 3.7% with buccal fat pad flap use compared with 8.5% without (P = 0.39). Bayesian logistic regression showed a two-thirds reduction in the odds of fistula formation (odds ratio [OR] = 0.33; 95% credible interval [CrI]: 0.15-0.74), suggesting a high probability of a protective effect.ConclusionsThis study demonstrates that the use of buccal fat pad flaps in primary cleft palate repair is an effective adjunct associated with a reduced incidence of post-operative oronasal fistula.

Faltering weight in infants with cleft lip and palate.

Wide cleft palate repair poses a considerable challenge due to the potential for closure under tension, and an elevated risk of postoperative oronasal fistula and velopharyngeal insufficiency (VPI). Preoperative cleft width and Cleft Palate Index (CPI) are recognized as key predictors of outcome. This study presents Cleft Lip And Palate Association of Pakistan's (CLAPP) institutional experience with wide cleft palate repair, analyzing the influence of anatomical severity, surgical technique, and other variables on fistula formation and speech outcomes. A retrospective review was conducted of patients undergoing repair at CLAPP Hospital between January 2015 and December 2023. Data collected included demographics, cleft width, palatal shelf width, CPI, surgical technique, fistula location and rate, speech outcomes, and need for secondary speech-correcting surgery. Cleft width and CPI were stratified into predefined categories. Univariate and multivariate logistic regression were performed to identify predictors of postoperative fistula formation. A total of 293 patients (mean age 8 years, range 9 months-48 years) were included. Nearly one-third (35.5%) had cleft widths greater than the combined right and left palatal shelf widths. CPI distribution revealed progressive fistula rates from 12.1% in the narrowest group to 28.2% in the widest. The overall postoperative fistula rate was 21.2%, most frequently at the soft palate (27.4%) and hard-soft junction (12.9%). In univariate analysis, left palate width ≥ 1.1 cm and von Langenbeck repair were associated with significantly lower fistula rates, although only the latter remained significant in multivariate analysis (adjusted odds ratio = 0.34; 95% confidence interval = 0.16-0.72; P = 0.004). Bardach repair was preferentially performed in more severe, wider clefts, accounting for its higher unadjusted fistula rate. Preoperative and postoperative speech assessments (N = 173) showed a mean composite score improvement of 13.4%, with 8.9% requiring secondary speech-correcting surgery. Wide cleft palate repair outcomes are strongly influenced by cleft morphology, with CPI emerging as a key prognostic tool. While von Langenbeck repair demonstrated lower adjusted fistula rates, technique selection remains contingent on preoperative assessment, with Bardach repair favored in severe cases. Long-term monitoring for VPI is crucial, with early repair and tailored technique selection critical for optimizing functional outcomes in this challenging subset.

Assessment of levator veli palatini muscle morphology and its correlation with velopharyngeal function using dynamic magnetic resonance imaging in children with repaired cleft palate.

Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction, often accompanied by a cleft palate. Severe cases pose additional challenges in surgical management due to anatomical abnormalities. A 3-year-old male with severe PRS underwent a cleft palate repair procedure, which was a multidisciplinary approach, and the successful repair of the cleft palate and uneventful postoperative recovery were attributed to the team's collaborative efforts. This case also highlights the importance of genetic evaluation and testing in managing PRS cases. This case highlights the importance of thorough preoperative assessment, advanced airway management skills, and genetic evaluation for better patient outcomes. Future research should explore innovative techniques and strategies to improve the outcomes of patients with PRS and other complex congenital conditions.

Background: Recurrent palatal fistulas following cleft palate repair, particularly Pittsburgh Class V and VI defects, represent a distinct reconstructive challenge characterized by tissue ischemia, scarring, and volumetric deficiency. The "failure of failure" in these cases often precludes the use of local mucoperiosteal flaps due to the poor quality of the recipient bed. This study evaluates a standardized "dual-tissue" salvage protocol combining an anteriorly-based dorsal tongue flap with an autologous dermofat graft. Case presentation: A 21-year-old female with a recurrent, symptomatic Pittsburgh Class V-VI fistula measuring 15 mm by 12 mm underwent a two-stage reconstruction. The surgical protocol involved three distinct layers: (1) nasal lining closure via turnover flaps; (2) interposition of an inguinal dermofat graft oriented with the fatty surface facing the nasal layer to obliterate dead space; and (3) oral coverage using an anteriorly-based tongue flap. Speech outcomes were quantified using the Pittsburgh Weighted Speech Scale (PWSS) by an independent, blinded Speech-Language Pathologist. The procedure successfully achieved complete closure with no evidence of necrosis, dehiscence, or donor site morbidity. The total operative time was 145 minutes. Quantitative assessment revealed a robust improvement in speech resonance; the PWSS score improved from a severe 18/30 pre-operatively to a clinically competent 4/30 at 6 months post-operatively. The dermofat graft maintained volumetric stability, preventing the concave collapse often observed in single-layer repairs. Conclusion: The sandwich technique potentially reduces recurrence risk in high-grade fistulas by addressing the triad of failure: tension, ischemia, and dead space. The vascularized tongue flap protects the underlying graft, while the dermofat graft acts as a biological spacer and source of adipose-derived stem cells. This protocol offers a reproducible solution for complex craniofacial defects where local tissues are exhausted.

Background: Palate repair surgeries are being performed in Bangladesh as well as in whole world by different techniques. The study was done to compare early complications of Von Langenbeck and Bardach Palatoplasty techniques. Methods and materials: This prospective observational study was conducted with the Patients admitted with cleft palate with or without cleft lip into Department of Plastic Surgery, DMCH. A total of 60 patients were selected according to inclusion and exclusion criteria. Thirty patients were included in Group I who were underwent Von Langenbeck palatoplasty. Another Thirty patients were included in Group II and they underwent Bardach palatoplasty. P value was significant at &lt;0.05. Results: Majority of respondents belonged to age group 7-12 months and 13-18 months. The mean age was 13.1±4.51 (SD) in Group I and 12.6±4.58 (SD) Group II with female dominance. No statistical significance was noted in age, sex, and other demographic features between two groups. Postoperative hemorrhage (16.7% vs 20%), wound infection (16.7% vs 10%) and wound dehiscence (10% vs 6.7%) was statistically insignificant between two groups (p&gt;0.05). Only 10% in Group I and 6.7% in Group II experienced post-operative fistula formation without statistical significance (p&gt;0.05). No statistical significance was noted between two Groups according to age range. Conclusion: This study found no difference between Von Langenbeck and Bardach technique of palatoplasty in relation to early complication. However further long follow up study is recommended to validate these findings. Journal of Surgical Sciences (2021) Vol. 25 (1) : 30-35

The use of buccal flaps during primary palatoplasty may decrease the rate of complications such as dehiscence and fistula formation. This study aims to investigate if this use of buccal flaps results in perceived facial asymmetry of a patient. Photographs of patients with cleft palate who have undergone primary palatoplasty with unilateral, bilateral, or no buccal flaps at our institution were included in a de-identified survey. Respondents were asked to rate the facial asymmetry score (FAS) and which side appeared larger (cheek laterality score (CLS)). The cohort included 21 patients: seven patients in each group (bilateral, unilateral, and no buccal flaps). Of these patients, 11 (52.4%) are male, and 10 (47.6%) are female. A total of 35 completed survey responses were received. The mean CLS (1 being bigger on the left and 5 being bigger on the right) was 2.79±0.48: 2.85±0.5 for bilateral buccal flaps, 2.66±0.54 for unilateral buccal flaps, and 2.88±0.43 for none (P=0.7). Overall, the inter-rater reliability was good, using the intraclass correlation coefficient. On multivariate analysis, neither the FAS nor the CLS was significantly associated with the number of buccal flaps used. There was no significant difference between the perceived asymmetry of patients' status post-primary cleft palate repair. This suggests that patients can safely undergo palatoplasty with unilateral or bilateral buccal flaps without the concern for aesthetic impacts on facial symmetry.

Lipopolysaccharide (LPS), a conserved component of Gram-negative bacteria, is a potent immune activator that disrupts tissue repair when released during microbial dysbiosis. LPS-scavenging strategies are often limited by the poor accessibility of lipid A, the bioactive core of LPS, which is shielded by variable oligosaccharide structures and embedded in bacterial membranes. To address this, a synergistic LPS-binding hydrogel (OCMC-PMBP) is developed, combining polymyxin B (PMB) for lipid A-targeted bacterial lysis and polyethyleneimine (PEI) for electrostatic LPS capture. This system is applied to oronasal-perforating wounds, a complex and infection-prone condition associated with cleft palate repair. Clinical microbiome analysis and murine models reveal that LPS-TLR4 signaling contributes to immune dysregulation and impaired healing. OCMC-PMBP treatment reduces LPS levels, restores microbiota balance, suppresses inflammation, and accelerates epithelial regeneration and collagen remodeling. Integrated 16S rRNA sequencing, metagenomics, and single-cell transcriptomics show that the hydrogel reprograms immune cell phenotypes and modulates macrophage interactions with neutrophils, epithelial cells, and fibroblasts across healing phases. This study introduces a biomaterials design combining antimicrobial and immunomodulatory functions to resolve dysbiosis-induced inflammation and enhance regenerative healing in complex mucosal wounds.

Having nasal speech due to velopharyngeal insufficiency (VPI) remains one of the most difficult complications to manage after cleft palate repair. Over early childhood, persistent hypernasality can impede the psychosocial and communicative development of a child. The purpose of this study was to assess the results of secondary soft palate lengthening surgery on children older than five years with a history of primary palatoplasty and persistent nasal speech. In this study, 60 non-syndromic patients with cleft palate whose nasal speech was persistent after cleft palate repair were included from January 2018 to December 2024 at Misurata Medical Center, Libya. Each of them underwent soft palate lengthening, most by intravelar veloplasty, and some by posterior pharyngeal flap. All the patients had preoperative and 12-month postoperative speech evaluation from both perceptual (Pittsburgh Weighted Speech Scale) and instrumental (nasometry) analysis. For statistical analysis, paired t-tests were used, with P &lt; 0.05 considered significant. Of the total, 80% of patients had complete hypernasality correction, and 13.3% had partial correction. There was a significant improvement postoperatively on nasalance scores (48.5 ± 9.2% to 24.1 ± 6.8%, P &lt; 0.001). 85% of the patients had improved speech intelligibility, with more than 86% of parents satisfied with the overall results. 10% had transient snoring and 5% had wound dehiscence, both classified as minor complications and were conservatively managed. For patients older than five years, soft palate lengthening is a secondary procedure that is both safe and effective for persistent nasal speech after cleft palate repair. It shows remarkable positive outcomes in resonance, intelligibility, and psychosocial confidence