The patient was a 12-year-old female who presented with unilateral cleft lip and palate, facial asymmetry, mandibular protrusion, resorption of condyle heads, and transverse maxillary deficiency. At the age of 13 years 10 months, maxillary expansion and autogenous bone graft were performed to improve the maxillary collapsed arch. Aged 14 years 10 months, she described symptoms of temporomandibular joint pain and dysfunction. Segmental Le Fort I osteotomy and intraoral vertical ramus osteotomy (IVRO) were performed at the age of 15 years 11 months. Segmental Le Fort I osteotomy resulted in improved sagittal and transverse discrepancy of the maxilla. After IVRO, facial symmetry, a good facial profile, and disappearance of TMD symptoms were achieved. The occlusion and esthetics were stable after 5 years of retention. © 2007 Elsevier Ltd and the Japanese Orthodontic Society.