(A) The minimal incision technique: (a) incision lines. Within the hard palate, the mucoperiosteum is elevated from the nasal and oral sides of the palatal shelves. In wide clefts, the greater palatine vessels are, when necessary, carefully dissected free in order to get better mobility of the oral mucoperiosteum. Through the lateral incisions, the hamulus is identified and the tendon of the tensor veli palatini muscle is slipped over the hamulus. In medial direction, the muscles are released from the posterior border of the hard palate. (b) The nasal, the muscle, and the oral layers are sutured separately. The wound surfaces behind the maxillary tuberosities are only sutured if this is possible without stretching the tissue. (B) The minimal incision with muscle reconstruction technique: (a) incision lines. The first steps are similar to the MI technique. The oral mucosa of the velum is then dissected off the musculature by knife and blunt dissection to the posterior border of the velum and laterally to the pterygoid hamulus. The nasal mucosa is sutured in the midline and then the muscle and the tendon of the tensor are divided from the posterior hard palate by an incision parallel to it. The tendon of the tensor veli palatini muscle is divided on the medial side of the hamulus and the muscle dissected from the nasal mucosa backward until the levator muscle is visualized laterally. The levator is then dissected so that the muscle bundles are felt to be freely mobile on each side and is united with sutures in the midline. (b) The nasal, the muscle, and the oral layers are sutured separately. The wound surfaces behind the maxillary tuberosities are only sutured if this is possible without stretching the tissue. (Illustration by L. Raud Westberg. Used with permission by Nyberg et al. (10), The Cleft Palate—Craniofacial Journal, SAGE Publications, Inc.).