The primary goals of cleft palate surgery include normal speech, normal facial growth, and normal hearing. Ideally, all of these could be achieved with the perfect surgical procedure, but palatoplasty outcomes rely on more than operative skill. The optimal plan for primary cleft palate repair requires consideration of both perioperative factors and essential timing of a select palatoplasty protocol. Important perioperative considerations include patient weight and nutritional status, infectious complications, bleeding risk, concomitant procedures, overall medical complexity, and associated syndromes or other anomalies. The key long-term factors for consideration include choices of timing and technique to help achieve the best possible speech, hearing, and growth outcomes. The literature is replete with investigations that attempt to define the relative importance of these different factors and associated outcomes. This chapter helps identify and clarify issues surrounding these short-term and long-term considerations for cleft palate care.