Congenital sublingual/lingual cysts are rare, and may present with feeding difficulty; and rarely with respiratory distress in the neonate. A seven days old male neonate weighing 2.6kg was referred to a teaching hospital in Nigeria with a swelling in the oral cavity noticed at birth; associated with symptoms of inability to breastfeed, close the mouth and partial airway obstruction. Complete airway obstruction occurred, with cannot intubate- cannot ventilate situation during inhalational anaesthesia for surgical treatment, which was successfully managed. We report the case to highlight the simple but life saving approach of needle aspiration in airway management for a cannot intubate- cannot ventilate situation due to a giant neonatal sublingual cyst.
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