Objective: The cleft lip and/or palate is the most common congenital anomaly with a high incidence within developing or low-income countries. To overcome the disease burden, humanitarian international missions are essential. In mission operation, patients never underwent any type of preoperative hospital care. Moreover, lots of patients past appropriate time of surgery. Therefore, we investigated primary palatoplasties in mission environments with regard to patients’ age and operation modality. Materials and Methods: The subjects included 106 patients who wanted palatoplasty during cleft missions in Vietnam. Medical records and peri-operative clinical photographs were analyzed retrospectively. Results: Primary palatoplasty was performed at the age of 72.5 months on average. Clinically, incomplete cleft palate was 61.3%. Main surgical technique was V-Y push-back operation with intravelar veloplasty (68%). Additional surgical procedures were pedicled buccal fat pad (33%) and vomer flap (16%). Postoperatively, no motality and any transfusion was not performed. Until 1 month after palatoplasty, fistula rate was 3.8%. Conclusion: For management of untreated cleft palate, which past the appropriate time of palatoplasty, pedicled buccal fat pad could be a reliable additional procedure to decrease postoperative fistula rate.