An approximately five-year-old female intact domestic short hair cat was surrendered as a stray to the SPCA of Tompkins County with no reported history. On presentation, the shelter's veterinary intern noted moderate bilateral nasal discharge, stridor, and deep anterior chamber in her right eye. She was otherwise found to be healthy. She was housed in an isolation unit and treated empirically for an upper respiratory infection with doxycycline. When she failed to respond, an anesthetized oral exam was performed. This revealed a 5 mm oronasal fistula at the junction of her hard and soft palates, just to the right of midline. Because of the difficulty of surgical repair and temporary decrease in symptoms, no action was initially taken to repair this defect. The doxycycline was discontinued because it was not addressing the primary cause of the patient's respiratory signs. She was spayed and monitored post-surgically on dry food only. Although she continued to have mild nasal congestion, she was made available for adoption with full disclosure of her defect and a recommendation to feed only dry kibble which gave her the least amount of difficulty. However, over the course of two weeks, she developed additional discharge and increased respiratory signs. On re-examination by the veterinary team, either surgical repair or euthanasia was recommended due to increasing concern for the cat's welfare in the shelter and the ability of an adopter to provide reasonable care. The patient was referred to Cornell University Hospital for Animals for a head CT ( computed tomography) scan and oral surgery to repair the fistula. CT revealed a defect in the right palatine and presphenoid bones leading to communication between the oral cavity and nasopharynx, as well as atrophic rhinopathy from chronic inflammation in the nasal passages. A split palatal U-flap was performed to repair the defect, and the patient had a successful recovery.