The Furlow palatoplasty, or double-opposing Z-plasty, is a surgical technique that results in palatal lengthening and transposition of the levator veli palatini musculature from sagittal to transverse orientation. Patients with velopharyngeal dysfunction and sagittal orientation of the levator veli palatini musculature are candidates for Furlow palatoplasty. These patients fall into two main categories: those with a submucous cleft palate and those with a previously repaired cleft of the secondary palate. Preoperative evaluation and selection of patients are important, as velopharyngeal gap size may be associated with speech outcomes after Furlow palatoplasty. Furlow palatoplasty is unlikely to cause airway obstruction.