**7. Conclusions**

Cleft palate repair using a modified V-Y palatoplasty combining with a large Z-plasty and a mucosal graft on the nasal side of the velum for symmetrical muscular reconstruction based on the surgical strategy that approaches each anatomical and pathological abnormalities of cleft palate. Following palate repair based on our surgical strategy, patients' speech was significantly improved, and the nasalance scores were recovered to almost the same levels as those of Japanese children without cleft palate.
