Fifty-seven cleft palate patients underwent primary repair with Furlow palatoplasty by the same surgeon from January 2001 to January 2005. There were 8 fistulae, 7 of which occurred out of 9 patients treated between July 2003 and January 2004 when operations were resumed after the outbreak of severe acute respiratory syndrome in Hong Kong; 1 minute fistula occurred after this period and closed spontaneously. Longer operation time and higher proportion of Veau classes III and IV clefts were noted in the fistula group. The high incidence and cluster occurrence immediately after SARS could be related to changes in the provision of nursing care and the level of parental supervision, in addition to more difficult operations encountered as reflected by more extensive clefts and longer operation time. We would like to emphasize that expert nursing care and close supervision with the help of parents play a very important role in achieving the best possible clinical outcome from cleft palate surgery in pediatric patients.