1. DR, Medhat M.Ibrahim

2. The surgical purpose of primary cleft palate repairer velopharyngeal incompetence treatment 1-To provide an apparatus that permits adequate velopharyngeal function. 2-Development of normal speech quality. 3-Prevent recurrent chest infection. 4-Recurrent otits media.

3. The velopharynx is, partial, totally abnormal Morphology Muscular structure function

4. Von Langenbeck is perhaps best known today as the "father of the surgical residency Among his most well- known "house staff" were such illustrious surgeons as Billroth and Kocher.

5. Described a technique for closure of cleft palate. Every repair performed today incorporates this principles of: Moving mucoperiosteal flaps medially to close.the palatal defect

7. 1868, Billroth thought that fracturing the ptyrigoid hamulus would improve the outcomes of cleft palate repair.

8. Described the V-Y repositioning technique for repair of incomplete clefts or cleft of secondary palate

9. FURLOW, IN 1986 FURLOW FLAP Furlow, in 1986, described a double- reverse Z-plasty technique to close palatal defect and elongate the soft palate.

10. Many reports state that dynamic repair of velopharyngeal function results from muscle reconstruction procedures. Which include; palatoplasty pharyngoplasty

11. passavant's 1862 Meucoperiosteal flap palatal muscle repair (1949)Dieffen bach-Warren techniqu. velopharyngeal closure with normal speech, the results were too often disappointing

12. evaluate the results of correction of cleft palate with palatal muscles reconstruction. Velopharyngeal closure is achieved by tension in the velum and its elevation toward the pharyngeal wall that moves toward the rising velum and diminishes the lumen of the velopharynx

29. Thirty patients (24 primary and six recurrent) with cleft palate were corrected by modified velopharyngeal sphincter reconstruction over a period of 54 months. The operative time for primary cleft palate repair was 75-90 min, this time being increased by 15-30 min during repair of the recurrent cleft palate.

30. Mean follow-up was 36 months, the range being 2-4 years. Few complications were encountered and tow patients had partial obstructions to the airway that required close post-operative observation and treatment with steroids during the first 24 hours

31. Minimal post-operative bleeding developed in three patients and stopped spontaneously without further interference. The exposed bones of the palate seen after moving the mucoperiosteal flap backward become covered by granulation tissues within 3-7 days

32. The wounds of the oral layers had healed completely with No dehiscence, none of the patients developed oronasal fistula No nasal regurgitation to solid or fluid food.

33. Children stayed in the hospital for a median of 4 days (range, 3-8 days). tolerated oral fluid in the same night after full recovery from anesthesia.

34. :The speech evaluation has shown that No hypernasality No audible nasal escape were demonstrated in the single-word test in any of the Corrected patients

35. the continuous speech test, satisfactory articulation and intelligibility was noticed in all cases specially at the first years of education and secondary pharyngoplasty was never indicated in any of the corrected patients

36. Conclusion: The designed modification in the closure of incomplete cleft palate by V-shaped flap plasty at the junction between the soft and hard palate nasal mucosa allows repair of cleft palate without overlapping of suture lines in the region of junction of the hard and soft palate. Thus, there is no possibility of occurrence of oronasal fistula. The designed modification also elongates the soft palate and narrows the oropharyngeal isthmus, with good speech outcomes and no need for further speech- supporting operations.