Hemifacial microsomia is defined as a condition affecting primarily aural, oral, and mandibular development and its clinical features may vary. In this paper we report a case of hemifacial microsomia with cleft palate. A Japanese girl 8 months of age was referred to our clinic for the treatment of cleft palate. Clinically, she had hypoplasia and inferior displacement of the left auricle, stenosis of the external auditory canal, a hypoplastic mandible, and facial palsy at the left side of the lower lip. There was no significant asymmetry of the maxillary dental arch or soft palate, and the left side of the soft palate showed mild hypokinesia. Palatoplasty with a push-back method was performed under general anesthesis at the age of 1 year 5 months. A few reports have shown a trend toward velopharyngeal insufficiency in hemifacial microsomia due to hypoplastic palatal muscles and poor neural control of these muscles. In the future, comprehensive speech therapy will be required in this patient.