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Background: Comprehensible speech is the goal of cleft palate surgery. Straight-line repair with intravelar veloplasty does not always transpose the entire levator muscle and risks postoperative velopharyngeal insufficiency (VPI). In contrast, Furlow palatoplasty allows palatal lengthening and repositioning of the levator muscle. We hypothesize that a conversion Furlow palatoplasty may allow for long-term correction of VPI that resulted from failed primary repair, obviating the need for pharyngoplasty.