Pierre Robin sequence is a pathology derived from alterations in the first and second branchial arches. Patients have breathing problems due to micrognathia and glossoptosis, causing severe upper airway obstruction and frequently requiring mechanical ventilator assistance.

Classical techniques to prevent airway obstruction were prone position with a high mortality. Tracheostomy and gastrotomy were the first surgical approaches with a high morbid-mortality rate associated to them.

Mandibular distraction osteogenesis, in neonatal patients, allows lengthening the mandible, improving breathing and swallowing disorders, with an etiological treatment.

We recommended an intraoral approach to avoid scars on the skin, and we introduced a new way to anchor the external device, with transfixing Kirschner wire in the proximal (mandibular ramus) and distal segment (chin zone), that showed good results and stability during the period of distraction and consolidation, with optimal results on improving the upper airway, avoiding tracheostomy.