Objective The aim of this research was to study the frequency of Le Fort I osteotomy (LFI) in cleft patients treated according to the protocol of the Erasmus University Medical Center, Rotterdam. Design Retrospective cohort study. Patients 508 cleft patients born between January 1, 1983, and December 31, 1992, were evaluated. Main Outcome Measures Frequency of LFI and correlations with type and extent of cleft, gender, number of previous surgical procedures, age during alveolar augmentation, and missing teeth, respectively. Results 251 patients met the inclusion criteria. Overall, 28 of the 251 patients (11.2%) required LFI: none for cleft lip (0.0%); 2 of 43 (4.7%) for cleft lip and alveolus; 24 of 100 (24.0%) for cleft lip, alveolus, and palate; 2 of 50 (4.0%) for cleft palate; and none for submucous clefts or the miscellaneous group (0.0%). The frequency of LFI increased with the severity of the cleft type. The number of previous surgical interventions is significantly higher in cases with an indication for LFI (p < .001). The frequency of LFI is significantly higher in male cleft patients (p < .05). Conclusions The overall frequency of LFI in the study group was 11.2%; this increased with the severity of the cleft type. A significant difference was noted in the number of previous surgical interventions between patients with and without an indication for an LFI. Delayed closure of the hard palate in the protocol might have influenced the low frequency of LFI.