Mandibular distraction osteogenesis is an effective tool with which to correct facial asymmetry, restore proper occlusion and, more importantly, create an appropriate airway in the micrognathic infant. As a component of many syndromes, micrognathia can impair feeding and speech development and can obstruct the neonatal airway. However, bony lengthening secondary to external mandibular distraction osteogenesis can provide added space, preventing oropharyngeal soft tissues from occluding the airway. Although external distraction of the mandible has been applied for more than a decade, this procedure often proves technically challenging. Here, as a supplement to their video presentation, the authors present a practical discussion of their current technique for mandibular distraction osteogenesis using an external device in a child with Treacher Collins syndrome.