Palatal fistula is common in cleft patients. Palatal fistula repair is difficult, and there is 10% to 30% recurrence rate. Application of nasopalatine Island advancement flap for easy closure of medium size anterior palatal fistula in isolated cleft patient is demonstrated. Anatomic basis, advantages, and limitations of this new flap are explained. Nasopalatine Island advancement flap is a useful aid for easy closure of medium size anterior palatal fistula in isolated cleft patient.