After institutional review board approval was obtained, a retrospective medical chart review was performed to identify all children treated with MDO for upper airway obstruction from January 1997 to January 2006. Inclusion criteria were bilateral MDO performed at an age younger than 3 months, with a minimum follow-up of 3 years. Thirty-seven patients who underwent bilateral MDO at an age younger than 3 months were identified. Twenty five of these were performed more than 3 years ago. Of these 25 patients, 6 were lost to follow-up, leaving 19 patients who met the inclusion criteria for the study. Records were reviewed for outcomes data regarding airway maintenance, oral feeding, and speech intelligibility. In addition, incidence data were extracted regarding the long-term complications of MDO such as need for an additional MDO procedure, rate of anterior open-bite deformity, facial nerve damage, hypertrophic scarring, and tooth loss. A quantitative outcome measures scale was developed based primarily on functional outcomes, and patients were scored based on long-term postoperative complications as well as airway and feeding goals. A 10-point scale was created, with favorable results scoring highest and corresponding to the best functional level, based on the following outcomes: 1 point each was given on avoidance of a short-term or long-term complication such as postoperative open-bite deformity (defined as the inability of the maxillary incisors to overlap the mandibular incisors), hypertrophic scarring, facial nerve injury, mandibular tooth damage or development of mandibular cyst, development of unintelligible speech (as rated by a certified speech and language pathologist with experience in working with patients with cleft lip and/or palate), or eventual recommendation for an additional mandibular distraction procedure. Other outcomes such as tracheotomy decannulation and removal of G tube were also taken into consideration. Two points were allotted to patients who avoided tracheotomy or G-tube placement altogether, and 1 point was given to a patient for eventual removal of a previously placed feeding tube or tracheotomy tube following MDO. “Good” outcomes were considered for those with scores of 9 or 10, “intermediate” outcomes for those with scores of 7 or 8, and “poor” outcomes for those with scores of 6 or lower (Table 1).