Unfortunately, primary closure of the palate is not completely successful in all patients. In some patients, an opening (fistula) remains in the (anterior) hard palate allowing food and speech to leak through the nose. A second problem is that the (posterior) soft palate may not be long enough or move far enough to close off the nasopharynx. This is called a velopharyngeal incompetence. These patients may also suffer from nasal regurgitation and hypernasal, unintelligible speech. Both palatal fistula and velopharyngeal incompetence will require secondary surgery. Any information gained from review of surgical outcomes of the primary palatoplasty might improve surgical success and reduce the number of secondary surgeries required. This would reduce possible morbidity to the patient and expense to the families.