Photograph (panel A) and panorex radiograph (panel B) of a child with Pierre Robin sequence undergoing mandibular distraction osteogenesis. The procedure typically is performed in early infancy in an effort to avoid a tracheotomy. Mandibular distraction osteogenesis involves bilateral division of the mandibular body and gradual advancement with an adjustable fixation device (panel A). New bone is gradually laid down in the tissue defect. The tongue moves progressively forward with the mandible, improving airway obstruction.