INTRODUCTION: This study was performed to assess the efficacy of the nasal lining flaps for closing the nasal floor in unilateral and bilateral cleft lip and palates. We believe this technique is superior to traditional techniques, resulting in a low rate of fistula formation at the alveolus. Some surgeons do not close the nasal floor during primary cleft lip repair, leaving a symptomatic alveolar fistula that is present until the alveolar bone grafting. The traditional approach for closure involves the use of anteriorly-based medial (M-flap) and lateral (L-flap) skin flaps. However, these skin flaps are thin and provide notoriously unreliable coverage. The nasal lining flaps were devised to reconstruct the nasal floor with robust, well-vascularized flaps. These flaps create an anatomic reconstruction of the nasal floor while providing support for the alar base(s). The undersurface of the one-layer repair eventually fills in secondarily. METHODS: Cleft repairs performed by two craniofacial surgeons at a university children’s hospital were identified. One surgeon used the nasal lining flaps while the other used primarily M- and L-flaps to close the nasal vestibule. Patients were included in the study if they had a complete cleft lip and palate and at least 6 months of follow-up. RESULTS: There were 64 patients in the study. Thirty-seven (37) underwent closure with nasal lining flaps while 27 underwent closure using traditional techniques. The rates of alveolar fistula formation were 3% (1/37) and 30% (8/27), while the rates of non-alveolar fistula formation were 16% (6/37) and 15% (4/27), respectively. The lower rate of alveolar fistula formation in the group that underwent closure with the nasal lining flaps was statistically significant (p=0.003, Fisher’s exact test). There was no statistically significant difference in rates of non-alveolar fistula formation (p=1, Fisher’s exact test). CONCLUSION: The nasal lining flaps have multiple advantages. This technique closes the nasal floor at the time of primary lip repair, when visualization is easiest. The repair is simple to perform and has a high success rate. Closure of the alveolar region with soft tissue likely improves quality of life by preventing fluid or food regurgitation into the nose. The nasal floor closure does not prevent the need for bone grafting, but can make the surgery easier since the nasal side is already closed.