Background: Velopharyngeal insufficiency (VPI) is a common complications following cleft palate repair. Lengthening of the palate can improve velopharyngeal function, however current approaches such as the Furlow palatoplasty and sphincter pharyngoplasty have a number of disadvantages and are not suited to all patients.

Purpose: To lengthen the palate and repair oro-nasal fistulae using bilateral facial artery musculomucosal (FAMM) flaps.

Methods: 7 patients with VPI requiring surgery and 2 patients with a palatal fistula underwent the procedure. After transverse division of the soft palate, bilateral inferiorly based FAMM flaps are inset. The flaps overlie one another, with one serving as the nasal lining and the other as the oral lining. The donor sites are easily closed primarily.

Results: Follow up ranged from 6 months -10 years (average 45 months). There were no complications in this series. Increased palate length and good to outstanding improvement of speech was observed in all 7 patients with VPI. No recurrence of the oro-nasal fistulae was seen in the two patients.

Conclusion: Bilateral FAMM flaps can be safely used to repair oro-nasal fistulae and to lengthen the palate in patients with VPI. This gain in length translated into improved speech in our series.