Aim: This case demonstrates an orthodontic and surgical approach to a severe open bite malocclusion with cleft palate and neuropathy. Methods: Pre- and postsurgical orthodontic treatment involved a multi-bracket appliance, Le Fort I osteotomy, and sagittal split mandibular ramus osteotomy. The diagnostic background and the treatment procedures are sequentially presented. Conclusion: The combined orthognathic surgery and orthodontic treatment resulted in a significant correction of the occlusion.World J Orthod 2004;5:54–61.