Assessment of speech and the middle ear function of patients between the age of 3 and 7 years surgically treated by ARC (Furlow z-palatoplasty with a buccinator myomucosal flap) was done. Middle ear function was assessed by clinical otoscopic examination and by tympanometry to detect the presence or absence of middle ear effusion and the need for tympanostomy tubes. Speech outcomes were assessed using perceptual speech assessment for the degree of hypernasality, compensatory misarticulation and speech intelligibility. Nasopharyngoscopic examination of the patients was done for visualization of the velopharyngeal port, allowing assessment of the pattern and grade of velopharyngeal closure during speech and the presence or absence of a velopharyngeal gap

Inclusion Criteria:

• - Age 3 to 7 years
• 1ry cleft repair by furrolow with buccal myomucosal flap
• Non syndromic previously treated children
• Cleft repaired by the same surgeon

Exclusion Criteria:

• - Syndromic patient
• Cleft palate repair by any technique except furlow with buccal myomucosal flap