No major breakthroughs have occurred since Kawamoto last discussed this topic in the Clinics in 1976. Advances such as early surgery, cranial bone grafting, modern methods of fixation, and tissue expansion have been applied with success to craniofacial clefts as in the treatment of other craniofacial deformities. Twenty years have passed since Tessier first presented his classification of craniofacial clefts, and that interval has served to reinforce the magnitude of Tessier's contribution to craniofacial surgery.