Giant Cystic Hygroma in a Neonate: Fixing the Trajectory – Manual Maneuver for Airway Rescue

Airway management in neonates with massive cervical cystic hygroma remains a challenging anesthetic task. Distorted anatomy, mass effect, and pharyngeal compression can render standard intubation techniques ineffective, even if glottic visualization is achieved. We describe a 20-day-old neonate in whom endotracheal tube (ETT) passage repeatedly failed despite a good laryngoscopy view using video laryngoscopy. Successful intubation was ultimately achieved through a simple, manual maneuver retraction of the mass. This technique, by correcting the ETT trajectory rather than visualization, converted a high-risk, difficult airway situation into a smooth successful intubation. Incorporating such simple maneuvers into neonatal difficult-airway algorithms may enhance safety and outcomes.