In surgical management of cleft lip and palate, appreciation of the special anatomy and physiology of the human premaxilla is more important than the question of whether it is a separate bone. To take advantage of the potential of the premaxilla, both primary and secondary surgical procedures must strive to establish a nearly normal medial septal system and nasolabial musculature. To complement accurate muscle surgery of the lip and soft palate, the characteristics and functions of the mucoperiosteum that covers the palate must be respected. The quality of subsequent facial growth can be monitored with the architectural craniofacial cephalometric analysis. By adopting a physiologic approach to cephalometrics, the clinician can avoid some common errors of interpretation.