Distraction osteogenesis is an important option for the treatment of mandibular hypoplasia. This case report describes the treatment of a girl with mandibular hypoplasia and sleep apnea. She had a tracheostomy, followed by orthodontic treatment, including extraoral mandibular distraction osteogenesis to open the airway. Follow-up records 4 year 8 months after the distraction osteogenesis are presented.