It is characterized by vertical separation of the lip. However, the cleft area does not reach the nasal area. They have either an intact nasal sill or a Simonart band (Fig. 2.1).

It is characterized by complete vertical separation of the lip, including the nostril sill and alveolus. No Simonart band is followed. The position of the alveolar segments and the width of the alveolar cleft are also important factors when defining the cleft and therefore the treatment approach. Alveolar segments can be wide, narrow, collapsed, or not collapsed. According to the width and collapse rate of the segments, presurgical orthopedic treatment approaches can be used to align the arch shape and increase the columellar height of the nose, resulting in decreased tension in lip repair and benefits in final nasal anatomy (Fig. 2.2).

In this type of cleft, the premaxilla is not in alignment with the lateral alveolar segments due to the lack of connection with the lateral palatal shelves. Premaxilla is usually overprojected and may show rotation. Lateral shelves, on the other hand, are usually collapsed to the midline because of the lack of intact connection with the premaxilla (Fig. 2.3).

Mostly, the anterior nasal spine is congenitally missing or underdeveloped, resulting in the recession of the footplates, which leads to broad flat nasal tip and typical absent columella.

The patients born with cleft lip and palate go through lots of surgeries from the beginning of their lives. At the first months of their life, usually in the third month, they undergo a lip surgery (Semb et al. 2005). However, before the lip surgery, some nonsurgical approaches aim to bring both sides of the lip and prolabium together to ease further lip surgery by reducing the strain that possibly occur after the surgery. In these approaches, babies wear a plate that both eases sucking and brings the alveolar segments closer orthopedically (Santiago et al. 1998). At the same time, with part extending to the nose, it also helps to raise the nose tip by increasing the columellar length. The main purpose of lip surgery is both giving the baby an esthetically pleasing appearance and at the same time a good functionality to help sucking. Till then, the baby is fed with special feeders. Usually, these feeders have liquid flow control, and they are used with severe feeding problems. Feeding is also provided with the assistance of feeding plates after the lip surgery, till the palatal closure is performed. There is no general agreement about the right time for palatal surgery. However, the current consensus is that palatal repair should be performed around 18 months of age before meaningful speech develops.

This method was introduced in 1861 by Bernard von Langenbeck. It uses mucoperiosteal flaps for the hard palate repair. The flap is left attached to the alveolar margin, and the incisions are made through the cleft edges to release the mucoperiosteum. Additional lateral relaxing incisions are also involved to relieve tension in the midline repair (Agrawal 2009; Fisher and Sommerlad 2011).

This technique adopts V–Y procedure. As a result, mucoperiosteal flap and the soft palate are positioned posteriorly. It was believed that the palatal lengthening would improve the speech outcome. However, some studies show that it is not the case. This technique also has the disadvantage of increased maxillary growth restriction and large anterior fistulas due to raw area left for secondary healing after the pushback of the flap (Agrawal 2009; Fisher and Sommerlad 2011).

It is similar to von Langenbeck technique. However, the lateral releasing incisions are extended toward the alveolar margins. Therefore, the flap bases extend posteriorly to the palatine pedicles. This method allows closure without tension.

It is a single-stage palatoplasty, where palatal muscles are overlapped by the transposition of the Z-flaps. Z-plasty results in the lengthening of the soft palate because of its geometry. Therefore, this technique can also be used for the treatment of velopharyngeal incompetence. Lateral tightening can be considered as the main disadvantage of the technique. However, this problem can be overcome by lateral relaxing incisions (Agrawal 2009; Fisher and Sommerlad 2011; Furlow 1986).