Surgical procedures in cleft lip and palate repair are continuously evolving. In the international literature, many guidelines exist dealing with different timings and surgical approaches. The authors present a technical strategy on primary palatoplasty and the guidelines for the surgical management of cleft lip and palate adopted by the Department of Maxillo-Facial Surgery of the Università "La Sapienza" of Rome. This approach has been developed to allow a physiological facial growth and to preserve the essential main features of the stomatognathic system enclosing phonation and swallowing. Moreover, the authors present their own surgical technique for primary palate repair at 24 to 48 months with the galea-pericranium free flap.