Introduction: Oropharyngeal teratomas are rare, mostly benign congenital tumors that cancause life-threatening airway obstruction. However, extensive lesions with skull base and intracranial extension cause significant surgical and airway management challenges. Case presentation: A 37-year-old mother delivered a term male infant via cesarean section.The pregnancy was complicated by gestational diabetes mellitus and polyhydramnios. A thirdtrimester ultrasound detected an orofacial mass. The baby had APGAR scores of 7 , 9, and 9, with a birth weight of 2020 g. At birth, a pedunculated mass arising from the floor of the mouth suggestive of a teratoma was observed. The neonate developed seizures and apneas, which progressively worsened, necessitating intubation on day seven of life. Following stabilization, the mass was surgically excised, and histopathology confirmed amature cystic teratoma. However, a visible residual lesion remained, causing airway obstruction requiring tracheostomy . Imaging of the head and neck demonstrated a large solidcystic residual tumor involving and compressing the upper airway and eroding the left greaterwing of the sphenoid and temporal bones with extradural extension into the left middle cranial fossa (MCF). Despite a second excision, there was residual tumor extending from the skull base to the submandibular space with MCF involvement. A Percutaneous Endoscopic Gastrostomy tube was inserted for feeding establishment and is awaiting optimization of weight prior to thenext surgery . Conclusions: This case highlights the complexity of managing massive oropharyngeal teratomas with MCF extension. Multidisciplinary care with staged surgical excision, airway stabilization, and careful preoperative optimization are essential to improve outcomes.