High arch, “pseudoclefting,” submucous, and overt cleft palate are all common in Apert syndrome. When cleft palate occurs in combination with other facial differences characteristic of this syndrome, particularly maxillary hypoplasia, possible facial asymmetry/deviated septum, and choanal atresia, there is concern for heightened risk of worsened obstructive breathing after palate repair. Our review of the topic and institutional experiences shows that palatoplasty can safely be performed in Apert syndrome but is best delayed until approximately 24 months of age. Preoperative efforts should be directed at identifying and mitigating the risk of airway obstruction. Post-operatively, speech and language outcomes typically reflect broader cognitive and communication challenges more than palatal contributions to speech intelligibility. Following and supporting patients’ speech development through the completion of facial growth and final orthognathic procedures is critical, as Velopharyngeal insufficiency (VPI) can occur due to these later anatomic changes.