The management of cleft lip and palate patients should achieve good function, particularly concerning nasal breathing. For this purpose, we must have a sound knowledge of the pathological anatomy, to correct the deformity of the cartilaginous structures, and to restore a good muscular balance. However, surgery is the main cause of facial growth disturbances. Procedures which produce areas of denuded bone are the worst and the VY Veau-Wardill closure of the palate was abandoned for this reason. Since 1981, the new protocol consists of simultaneous repair of the lip, nostril and soft palate at 6 months of age, and a very simple repair of the hard palate at 18 months of age, without denuded bone or early orthopaedics. The procedure results in good facial growth at ten years of age, with less velopharyngeal insufficiency. The value of good management of the cleft alveolar arch with secondary periosteogingivoplasty saving the lateral incisor space, and the need for an early patent nasal air way are stressed.
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