Malformations, deformations and abnormal intermaxillary relationships varying in severity can be found in cleft lip and/or palate children. Such multiple deformities have an influence on speech resonance and articulation, as well as on masticatory, auditive and respiratory functions. Therefore, a multidisciplinary team should monitor these patients from birth on to adulthood. This article describes our treatment protocol, discusses the limitations of dental orthopedic action and the indications for orthognathic surgery. Timing and techniques of different surgical interventions are presented and the impact of these procedures on velopharyngeal function is evaluated.