Airway management in neonates with Pierre Robin sequence is often challenging. Advancement of the tongue base using mandibular distraction in neonates can avoid tracheotomy and is increasingly propagated. The surgical indication is very important. We establish indication. The result of the preoperative peripheral oxygen saturation of about 40% in the prone position is considered as indication. The distance from postpharyngeal wall to lingual root of more than 5 mm is considered as contraindication; however, distance of less than 2 mm is considered needing performing mandibular distraction in preoperative lateral cephalometric radiograph. A three-dimensional computed tomographic demonstrating severity of retrognathia was generated preoperatively in the computed tomography room. The osteotomies can be performed by extraoral approaches. Nowadays, for precise bone cutting, Surgybone (Silfradent Co., Sofia, Italy) devices have been introduced in maxillofacial surgery, which we used for extraoral-approach osteotomies in 6 patients presented in this study. Distraction was performed after bilateral oblique osteotomy and removed after 1-month fixation in the second stage. A follow-up examination after removal of the distractors was performed. Normal appearance and no apnea were observed at 6 months' follow-up.