A brief review of normal maxillary growth and the dysfunctional pathoanatomy of velopalatine clefts is presented. A plan of management for patients with these deformities is proposed; this is based on the degree to which the deformity departs from normal. The authors stress the importance of early, complete reconstitution of the soft palate and avoidance of the use of vomer flaps in the closure of the hard palate. The influence of the vomer, nasal septum, and labionasal musculature on postnatal facial development is discussed.