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Mandibular distraction osteogenesis (MDO) aims to relieve tongue-based airway obstruction in Robin Sequence (RS). We investigated direct laryngoscopy grade (DLG) improvement and difficult airway (DA) resolution following MDO. Retrospective cohort analysis. Three tertiary care institutions. Sixty-four infants with RS who underwent a single MDO procedure in their first year of life were identified from January 2010 to January 2019. The primary outcome was DLG pre- and post-MDO. Secondary outcomes included DA designation, pre- and post-MDO polysomnogr