Orthognathic surgery may be the last operation for the cleft lip and palate patients. The correction of jaw discrepancy can be performed by orthognathic surgery. The growth of maxilla affects by the cheiloplasty and palatoplasty. The mandibular growth of the cleft lip and palate patient follows the normal population. So cleft lip and palate patient can have a mandibular retrognathism or prognathism with similar incidence of the normal population. There are several considerations for the planning and performing orthognathic surgery in the cleft lip and palate patient. First, nasomaxillary and velopharyngeal anatomy are different from the normal population. This anatomic difference should be considered for planning and during operation to reduce complications after surgery. Second, the surgeon should decide which jaw will be operated. Third, if the maxillary surgery is planned, the surgeon should decide which technique will be used for maxillary advancements, such as Le Fort I osteotomy as a conventional orthognathic surgery or maxillary distraction osteogenesis. Fourth, the velopharyngeal function of the cleft lip and palate patient should be considered before and after the operation. Fifth, alveolar bone graft in the cleft alveolus area is also an important consideration. The last consideration is the airway behind the mandible. If the mandibular setback surgery is considered, the airway should be analyzed before the operation. In this paper, five considerations for orthognathic surgery in cleft lip and palate patients will be discussed.