The objective of the study was to provide a comprehensive review of the literature describing research done on the stability, adaptation and growth of craniofacial structures following distraction osteogenesis (DO). The design of the study was a literature review of clinical and experimental studies using electronic search with several keywords. Despite immediate normalization of craniofacial relationships after DO, post-distraction mandibular and midface stability and growth is variable in the long-term based on the initial condition. Unpredictable and/or unstable outcomes after DO can arise mainly from three main sources: 1) true relapse, 2) return to original morphology and 3) defective growth. Despite the biologic and clinical feasibility of DO in the craniofacial region, relapse, compromised adaptation, and defective post-distraction growth can lead to variable clinical outcomes. When important structures for the mandibular forward and downward displacement are rudimentary or missing in syndromic patients, DO can not 'correct' the condition and post-distraction growth will be defective. Non-syndromic patients have a better potential to respond favourably to DO.