Orofacial clefts comprise a range of congenital deformities and are the most common congenital malformation. Clefting has significant psychological and socioeconomic effects on patient quality of life and require a multidisciplinary team approach for management. The complex interplay between genetic and environmental factors play a significant role in the incidence and cause of clefting. In this review, evolution of craniofacial distraction over conventional orthognathic surgery and its complications are discussed. It has been suggested that DO offers several advantages over orthognathic surgeries in the treatment of patients with cleft lip and palate (CLP). The distraction osteogenesis (DO) is a method developed for induction of new tecidual formation between two segments of a bone for a slow and gradual force of traction (Ilizarov, 1989a; Ilizarov, 1989b; Meyer et al.,2001a). Cleft care requires that the surgeon be a member of a collaborative multidisciplinary team. Through close self–scrutiny, disciplined evaluation of the results, and a great deal of imagination, a number of plastic surgeons continue to advance cleft care, seeing as many challenges ahead as they encountered at the beginning of their careers.