Aim: To evaluate the effects of surgical intervention without adequate preoperative or postoperative orthodontic management. Methods: A patient with bilateral cleft lip and palate was followed for a 14-year period and assessed radiographically after numerous surgical and orthopedic interventions. Skeletal and dental relationships at the time of early superiorly based pharyngeal flap surgery were compared on serial lateral cephalometric radiographs to those after early alveolar bone grafting, vestibuloplasty with mucogingival grafting, comprehensive orthodontic intervention, orthognathic surgery, and rhinoplasty. The main outcome measure was the normalcy or proportionality of facial growth, as revealed by measurements and growth vectors on serial lateral cephalometric radiographs. Results: Proportional downward and forward facial growth occurred after early pharyngeal flap surgery, while later alveolar bone grafting and surgical revisions were coincident with disproportional maxillomandibular growth. Conclusion: Although the individual’s inherent variation in craniofacial form may be as important as the influence of surgery on facial growth, the timing and extent of orthopedic or surgical interventions affect the direction of that growth. World J Orthod 2001;2:341–349.