The Obwegeser/Perko modification of the high horizontal osteotomy for management of mature cleft palate/cleft lip patients is described in detail. Careful evaluation and treatment planning preoperatively are stressed. Three cases which emphasize the need for individual tailoring of the maxillary procedure are presented. Results were found to be uniformly good, with few complications. In that the skeletal deformity of maxillary micrognathia/retrognathia is readily corrected by high horizontal osteotomy, this procedure is an ideal modality for the late rehabilitation of the patient with a cleft palate.