Difficult airway management in a neonate with giant sublingual cyst: A Case Report.

Introduction: Congenital ranula cysts are rare epithelial retention cysts originating from major sublingual or submandibular salivary glands, with an incidence of 0.74%. Early presentation often involves severe symptoms, including airway compromise and feeding difficulties. Management options include needle aspiration, surgical excision, marsupialization, sclerotherapy, laser excision, and cryotherapy. Significant airway compromises due to these congenital ranulas often occur inneonates; however, limited studies address their airway management. Case Presentation: We present the management of a 2-week-old neonate with a huge congenital ranula with sublingual swelling, poor feeding, sneezing, inability to cry post-delivery, and had surgery done following initial resuscitation and nasogastric tube insertion. Intubation using avideo laryngo scope with lidocaine and adrenaline instillation was successfully carried out to maintain th eairway. The cyst was then successfully removed and marsupialization performed under general anaesthesia. Subsequently, the neonate was extubated 24 hours postoperatively without complications and discharged home after an uneventful recovery. Conclusion: Giant congenital ranulas pose significant challenges for airway management. First intention use of a video laryngoscope with lidocaine and adrenaline instillation can be an effective technique to manage an anticipated difficult neonatal airway when performed meticulously.