Mandibular prognathism has been described as one of the most severe maxillofacial deformities. The etiology involves systemic disease, genetic influence or neuromuscular imbalance. Treatment modalities include growth modification, comprehensive orthodontic treatment and combined orthodontic-orthognathic surgery. The early treatment attempts to restrain the prognathic mandible with external force. Skeletal anchorage is also currently used in conjunction with orthopedic appliance. The camouflage treatment is done in more severe cases using various techniques and other adjunctive procedures such as the use of skeletal anchorage and induction of regional acceleratory phenomenon. Mandibular set back can be done in combination with other surgeries to eliminate prognathic jaw. The surgical first approach and the minimal pre-surgical orthodontics (MPO) technique have been popular lately, but careful case selection is necessary. The stability and several factors that contribute to unfavorable treatment outcome are reported.