Although distraction osteogenesis (DO) is widely used, there is minimal information on its use in patients after radiotherapy. The mutilating effects of ablative head and neck surgery, and insufficient development of the craniofacial skeleton after childhood head and neck malignancies, frequently necessitate complex reconstruction techniques. The simultaneous expansion of soft tissue that comes with bony lengthening during DO is a unique phenomenon.1 In selected cases, it causes less morbidity and better esthetic results than any other surgical procedure. The effects of radiotherapy on the outcome of DO are still not clear. There are only a few case reports describing DO of the human craniofacial skeleton after radiotherapy. Most of these reports have dealt with mandibular DO.2, 3 and 4 Only 1 case of postradiotherapy midface DO has been described thus far. Grover et al5 presented a patient with radiation-induced orbital zygomatic hypoplasia, which was treated using a rigid external distraction device. Several animal studies have been performed to explore the advantages of hyperbaric oxygen in postradiation DO, but these studies were confined to mandibles.6 and 7 In the present article, 2 patients are presented with radiation-induced midfacial hypoplasia after childhood malignancies. These patients were successfully treated with rigid external DO in combination with hyperbaric oxygen (HBO) therapy.