Objective: This study aimed to conduct a computed tomography (CT)-based evaluation of anatomical changes in nasal morphology, nasal complex and upper airway volume, temporomandibular joint (TMJ) parameters, and bone density following craniofacial distraction osteogenesis (DO). Methods: A pilot retrospective case series was conducted on five patients (ages 1–27 years) who underwent maxillary, mandibular, or monobloc craniofacial DO. Preoperative and postoperative CT datasets were analysed using three-dimensional (3D) image processing software to quantify changes in nasal morphology (nasal index and nasolabial angle), airway volume (nasal complex and upper airway volumes), and skeletal (TMJ joint spaces, condylar volume, and bone density). Results: Postoperative upper airway volume increased significantly (mean +55%, (p = 0.043)), along with nasal complex volume (+147%) although insignificant (p = 0.090). Changes in nasal index and nasolabial angle were heterogeneous and non-significant. TMJ analysis revealed a significant reduction in the left posterior joint space (p = 0.013) and a significant increase in left condylar volume (p = 0.043). Bone density showed minimal changes postoperatively. Conclusion: Craniofacial DO induces anatomical adaptations, most notably a significant increase in upper airway volume and adaptive remodelling of the TMJ, while nasal soft-tissue parameters and overall bone density remain relatively stable. These findings highlight the value of 3D CT analysis for understanding the multifaceted responses to DO, supporting its role in objective postoperative assessment and patient-specific surgical planning. © 2026 The Author(s)