perform incision which was carried down to the level of the midline rhaphe limited to the soft palate and secondary hard palate to allow for advancement. The posterior palatal shelf was dissected using this approach at the subperiosteal level and the posterior musculature was then disinserted off the posterior palatal shelf including posterior tonsillar palatopharyngeus, medial Pterygoid muscles. The lateral nasal wall was dissected off the medial pterygoid at subperiosteal level until the base of skull was reached. This allowed us a turnover flap of the nasal mucosa. The vomer was incised in the midline over limited distance on the midline posteriorly. This allowed us to reapproximate and suspend the nasal mucosa at subperiosteal level in that location. Next, the nasal mucosa of the soft palate with a small amount of muscle was approximated using interrupted sutures of 5-0 Vicryl. The oral closure was done in similar fashion using small amount mucosa and more perimysium and muscle layer closure. This was done in interrupted sutures. Inverted horizontal mattress sutures were placed to approximate nasal mucosa to the vomer periosteum at the level of the secondary hard palate.