Five of the 11 patients (45%) had partial or complete lip dehiscence after primary BCL repair. One likely reason for this high incidence of lip dehiscence is the presence of a protruding premaxilla at the time of primary lip repair. Repositioning of the protruding maxilla, either surgically or nonsurgically, permits a better repair of the lip by relieving undue tension. Nonsurgical repositioning with such devices as elastic traction, nasoalveolar molding, or active appliances (such as the Latham device4) is not practical because these devices are not readily available or affordable in Guatemala. Surgical correction thus consists of 2 possibilities: (1) a planned lip adhesion with a definitive repair staged at a later date or (2) surgical setback of the premaxilla. Because of the lack of long-term follow-up, it is doubtful that surgeons on cleft lip mission trips routinely plan a 2-staged lip repair with initial adhesion. Surgical excision of the premaxilla is not advocated because the premaxilla is recognized as the keystone of the maxillary arch. Premaxillectomy in an infant causes flattening or concavity of the midface, loss of support for the upper lip, and failure of forward growth of the nose. The risk of premaxillary necrosis is real when the premaxillary setback is performed with the labial repair. However, in my 2 patients, the premaxilla remained pink and bleeding after the setback.