Objective <p>The current study aimed to evaluate the speech outcome of primary Furlow palatoplasty with buccal myomucosal flap (FPBF) versus two flap palatoplasty (TFP) in patients with cleft palate.</p> Materials and methods <p>Thirty patients with cleft palate were included in the current study. Fifteen patients received the primary FPBF as the surgical palatal repair technique, while the other 15 patients received the primary TFP as their cleft palate repair. All surgeries were done by a single surgeon at the age of 9–12 months. Speech assessment was done at the age of 4–8 years, including the amount of hypernasality, speech intelligibility, compensatory misarticulation, and nasopharyngoscopy VP valve competence.</p> Results <p>Statistically significant improvements were detected in the 4 assessment methods while comparing primary FPBF versus the TFP groups’ scores.</p> Conclusion <p>Primary FPBF might be able to improve the speech outcome in comparison to TFP in patients with cleft palate.&#xa0;</p> Clinical significance <p> Primary FPBF improves the amount of hypernasality, speech intelligibility, compensatory misarticulation, and nasopharyngoscopy VP valve competence. Accordingly, it limits the need for further VP repair surgeries.</p> Trial registration <p> Clinicaltrials.gov (NCT06856330).</p>