Background: Oronasal fistula (ONF) is the commonest complication associated with cleft palate surgery. The main symptoms associated with ONF are nasal regurgitation of food matter and hypernasality of voice. Repair of cleft palate under tension is considered to be the main reason of ONF though vascular accidents and infection can also be the cause. Most of the ONFs are situated in the hard palate or at the junction of hard and soft palate. Correction of palatal fistula using facial artery based musculo-mucosal (FAMM) flap as one of the alternative management of repair of recurrent palatal fistula, especially after failure of previous attempt of repair. Materials and Methods: In the current study 10 cases of recurrent palatal fistula were covered by facial artery based musculo-mucosal (FAMM) flap. Most cases were due to failure of primary cleft repair. Results: Five cases healed completely, 2 cases showed total flap necrosis, 2 cases showed partial loss of the edge of the flap, and 1 case showed hanging of the flap. 7 cases showed symptoms improvement e.g. Regurgitation and nasal tone even in cases with partial flap loss. Conclusion: The use of facial artery based musculo-mucosal (FAMM) flap for repair of recurrent palatal fistula showed satisfactory results as regards flap viability and providing a suitable cover of palatal fistulas in cases with failure of other methods. The use of hand held Doppler proved to be essential in pre-operative delineation of the facial artery.