This study aimed to evaluate the importance of using the buccal myomucosal flap in cleft palate repair. This is a retrospective comparative study between two centers in which almost the same technique of cleft palate repair is used. The main difference in the repairs is that a buccal myomucosal flap is used as a part of the operation in one center and not in the other. The patients were divided into two groups. Group A was composed of the cases operated at the Craniofacial Institute in Southfield, MI, USA by the second author. In these, a buccal myomucosal flap was used as a step in the cleft palate repair. Group B contained the cases operated in the Plastic Surgery Department Khoula Hospital, Muscat, Sultanate of Oman using the same procedure but without using the buccal myomucosal flap. The duration of the study was from January 1995 to June 2005. The cases were assessed for oronasal fistulae of the secondary palate. The development of velopharyngeal incompetence (VPI) after a minimum follow-up period of 3 years requiring operative intervention was also assessed in the two groups. In group A (using the buccal myomucosal flap), the incidence of oronasal fistulae of the secondary palate was found to be 2 of 126 patients who underwent cleft palate repair (1.6%). The incidence of VPI requiring pharyngoplasty was found to be six out of 94 patients followed up for a period more than 3 years (6.4%). In two patients, buccal flap division of the pedicle was required because the patient was biting on it. In group B (buccal myomucosal flap not used), the incidence of oronasal fistulae of the secondary palate was 14 out of 299 patients who underwent cleft palate repair (4.6%). The incidence of VPI requiring pharyngoplasty was 36 out of 146 patients followed for a period of more than 3 years (24.7%). The incidence of fistulae and VPI development in both groups was found to be decreasing as experience with the technique increased. The use of the buccal myomucosal flap in cleft palate repair has proven to be an effective tool in the reduction of the incidence of fistula formation and VPI. The flap allows cleft palate repair without tension, and this has decreased the incidence of fistula formation. Adding an additional length to the nasal layer of the palate by using this flap also decreases the incidence of VPI significantly. If the flap needs to be divided, it can be performed as an outpatient procedure.