Purpose: Retrognathia and glossoptosis can cause airway obstruction in the neonatal and paediatric populations. Critical cases require intubation and consideration of tracheostomy. Mandibular distraction (MD) aims to alleviate airway obstruction by advancing the mandible and attaching soft tissues anteriorly. Successful secondary MD allows decannulation of tracheostomy. MD in retrognathic neonates with severe airway obstruction can prevent the morbidity associated with a tracheostomy. Methodology: Patients who underwent MD over the years 2013-2023 at our tertiary paediatric centre were identified. Patient characteristics, indications for surgery, and time between MD and successful tracheostomy decannulation were recorded from electronic health records. MD-specific complications were identified. Results: Of 9 patients who underwent MD, 2 underwent primary neonatal MD, avoiding tracheostomy. 7 underwent secondary MD following tracheostomy. Three patients had a syndromic association, of which two had Treacher-Collins syndrome. The mean follow-up period was 7.7 years. The average age at tracheostomy was 13.7 weeks. The average age at mandibular distraction was 0.1 and 2.3 years for primary and secondary MD cases respectively. For secondary MD cases, the average time from MD to decannulation was 59.8 weeks. One patient failed to decannulate, after two separate mandibular distractions. For primary MD cases, the average time from MD to spontaneous ventilation was 1.7 weeks. 3 patients had MD-specific complications, of which two had crossbite, and one with unilateral mandibular non-union. Conclusion: In a selective group of neonatal patients MDO can successfully relieve airway obstruction and avoid the requirement of tracheostomy.