Two different procedures for treating patients with cleft palate are evaluated. The first procedure was push-back palatoplasty performed simultaneously with San Venero Roselli's pharyngoplasty before 18 months of age. The second procedure was isolated push-back displacement. Three hundred and forty-seven patients were reviewed. The two procedures were compared relative to the occurrence of velopharyngeal insufficiency (VPI), severity of insufficiency, velopharyngeal closure pattern, movement of the lateral pharyngeal walls, and the influence of age at time of operation. Fewer of the patients who received the combination procedure presented VPI, and those who did tended to have less severe VPI. The groups were similar in velopharyngeal closure patterns and in movement of the lateral pharyngeal walls. Operation after 3 years of age tended to be associated with VPI. The combination procedure was helpful in preventing palatal shortening. Successful use of the combination procedure at an early age may prevent faulty articulation patterns.