الفهرس 
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Abstract
This study was planned in order to evaluate using collagen membrane as interpositional material between oral and nasal layer as third layer in closure of palatal fistula in cleft patients. It was conducted on twelve cleft patients aged between 7years to 20 years old with mean age 15.58 years, with residual palatal fistula located at hard palate who were operated at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University. The preoperative evaluation included clinical examination of site, size, shape of fistula and type of cleft, assessment of nasalance using nasometer, study cast to determine size and location of fistula and nasopharyngoscopy for assessment of velopharyngeal sphincter. All patients were followed- up for six months postoperatively for the following evaluations: 1. clinically: All patients were followed up clinically postoperatively at interval of 1st,2nd 4th week, 3rd and 6 months. Patients were evaluated for the following: 1. Wound healing. 2. Fistula recurrence. 3. Nasal regurgitation on feeding. 2. Nasometer: All patients evaluated postoperative using nasometer to record oral and nasal sentence and calculate nasalnce and compare with preoperative results to get changes in nasalance. The results of this study were : 1. Clinical: 1. Primary wound healing uneventfully was achieved without any signs of infection in all cases except cases NO.6, NO.10 and NO.11. 2. Wound dehiscence of oral layer occurred in 7 patients out of 12 but creeping of oral layer over membrane occurred in 4 out of 7 with soft diet and oral hygiene measurement. 3. No recurrence of palatal fistula was recorded in all cases except cases NO.6, NO.10 and NO.11. 4. No nasal regurgitation on feeding in all cases except cases with recurrent fistula. 5. Hypernasality improved in all cases except those with VPI and the recurrent 3 cases showed slight improvement. 2. Nasometer: All cases showed improvement of nasalance which measured by nasometer. All cases showed significant improvement in nasometer results ranged from 32% to 43% except cases No.6, No.10 and No.11 showed slight improvement in nasalance ranged from 15% to 39% due to recurrence of palatal fistula but with decrease in its dimensions and cases No.4, No.5 and No.9 showed higher degree of improvement but not too much due to VPI ranged from 28% to 37%, progress in nasalance ranged from 15% to 43% with mean value 33.92 and standard deviation equal 7.28 and results were statistically significant.