Fifty patients with submucous cleft palate (SMCP) who had had four different operations were reviewed. The operations were pushback palatoplasty (n = 18), pharyngeal flap (n = 21), pushback palatoplasty combined with a pharyngeal flap (n = 8), and Furlow palatoplasty (n = 3). Postoperatively the speech of 8, 19, 7, and 2 patients, respectively, improved so that it was within normal limits. A secondary pharyngeal flap was done for six patients, each of whom had previously had a pushback palatoplasty. They all improved, five achieving relatively normal speech, and one good speech. No patient developed hyponasality or airway compromise associated with the pharyngeal flap. The results show that pharyngeal flap and pushback palatoplasty combined with a pharyngeal flap seem to be more reliable procedures than pushback palatoplasty for patients with SMCP.