OBJECTIVE:To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate. DESIGN:We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level-dependent functional magnetic resonance imaging. SUBJECTS:Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers. RESULTS:Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient. CONCLUSIONS:The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.