This chapter reviews the dental and palatal anomalies in Apert syndrome and outlines key surgical principles and strategies for effective orthognathic management. Apert syndrome is a complex craniofacial condition caused by mutations in the FGFR2 gene, leading to premature fusion of cranial sutures and synchondroses. This results in characteristic midface hypoplasia, mandibular asymmetry, and dental and palatal anomalies that significantly impact function, aesthetics, and surgical planning. Orthognathic surgery plays a significant role in the multidisciplinary management of these patients, aiming to restore facial balance, improve airway function, and establish a stable occlusion. Dental crowding, hypodontia, and delayed eruption are common, complicating orthodontic alignment and pre-surgical preparation. Palatal anatomy, including a high-arched constricted palate with lateral swellings, further challenges maxillary mobilization and expansion. Surgical approaches such as Le Fort I–III osteotomies, monobloc advancements, and distraction osteogenesis are frequently required. These procedures are often complicated by extensive scarring from prior surgeries, necessitating modified techniques for safe and effective mobilization. Computer-aided design and manufacturing technology have become invaluable tools, enabling precise osteotomy design, patient-specific implant fabrication, and improved surgical outcomes. Successful treatment requires careful coordination among surgeons, orthodontists, and other specialists across the patient’s developmental timeline.