Odeann had a bilateral cleft of lip and palate. His original operations were performed by a team of overseas surgeons visiting Jamaica. He has lived in the UK for many years and was referred to our cleft team. Partly as a result of the surgery in Jamaica, his upper lip was tight, his upper jaw narrow and flat and his speech difficult to understand. Although the results of poor primary surgery can never be completely reversed, much can be done. Odeann had lengthy orthodontic treatment and operations on his upper jaw (to make it wider and to bring it forward), on his palate (to reconstruct the muscles and make it longer using tissue from the cheek) and on his lip (using a flap of tissue from the lower lip).