In newborns, who are obligate nasal breathers, bilateral dacryocystoceles pose a risk of airway obstruction. Definitive management is endoscopic marsupialization of the cysts with intravenous antibiotics. Figure 1 illustrates a case of a 7-day-old boy who presented with bilateral mucopurulent discharge, medial canthal swelling, and erythema (Fig. 1A). CT revealed bilateral dacryocystoceles (Fig. 1B1, arrows) and intranasal cysts (Fig. 1B2, arrows) obstructing each nasal pathway with no evidence of encephalocele. Despite initial clinical response to intravenous antibiotics, the patient had notable increased work of breathing overnight. Emergent intervention was planned; however, the anesthesia team deferred an overnight procedure given patient’s age. As a stabilizing measure, a RUSCH (Teleflex, Morrisville, North Carolina, U.S.A.) 12 Fr nasal trumpet (Fig. 1C) was used to protect the airway. The appropriate size was determined by measuring the distance from the nasal ala to the angle of the mandible. The trumpet was lubricated with water-based jelly, inserted in the left nare, and pushed along the floor of the nasal cavity below and medial to the inferior turbinate to restore normal breathing (Fig. 1D, 1). Figure 1E illustrates potential cyst expansion (Fig. 1E, 2, black arrow) under the inferior turbinate causing obstruction (Fig. 1E, 2, left, red), and how the nasal trumpet (Fig. 1E, 2) maintains the airway (Fig. 1E, 2, right, green) despite cyst expansion (Fig. 1E, 3, black arrow). Intraoperatively, the right (Fig. 1F1, 2) and left (Fig. 1F1, 3) intranasal cysts were visualized and then marsupialized (Fig. 1F2). The patient was discharged at postoperative day 3 on oral antibiotics and tobramycin–dexamethasone drops and recovered successfully without further intervention.