Mandibular deformities are common problems in reconstructive surgery and their management constitutes a challenging task for any reconstructive surgeon. Mandibular hypoplasia could be congenital, developmental or acquired. It is not only considered as a bone defect, but also comprises soft tissue deformity of variable grades of severity.The aim of this study was to evaluate the technique of distraction osteogenesis in the treatment of mandibular deformities as regards both functional and aesthetic aspects.This study included a review of literature for mandibular anatomy, histological concepts of bone regeneration in bone fracture healing, biomechanics of distraction, history of the experimental efforts done for the distraction technique and the current experience of distraction osteogenesis done for management of mandibular hypoplasia.The study also included an evaluation of other orthognathic methods used in reconstruction of the mandible as regards their virtues, drawbacks and complications. Distraction osteogenesis as the future line of treatment in management of other deformities concerning the cranio-facial skeleton was also included in this review.