Large fetal neck masses can present a major challenge to securing an airway at birth, with associated risks of hypoxia, brain injury, and death. The authors report a case of a giant neck mass, diagnosed in a fetus of 28 weeks, treated through ex utero intrapartum treatment procedure to assist in securing an airway followed by excision of the mass on the day after delivery. A multidisciplinary team approach, combined with an accurate prenatal diagnosis obtained through fetal ultrasound magnetic resonance imaging examination, was the key to a successful outcome. The role of the pediatric surgeon was initially to secure the airways through a tracheostomy followed by excision of the mass when the infant's vital parameters had been stabilized.