Objective: To present a case of a lymphangioma of the floor of the mouth with macroglossia and to identify the dilemma on the diagnosis and management for a pediatric case. Results: This case presented with a varied problems in the diagnosis and management of a 9 month old male apparently well with a noticeable tongue protrusion upon birth. Massive tongue enlargement, drooling of saliva, and feeding difficulty was seen few days after he accidentally tripped while playing. He underwent tracheostomy under total intravenous anesthesia to secure the airway. On MRI, the mass was consistent with lymphatic malformation of the floor of the mouth (lymphangioma). Initially managed conservatively with two sessions of intralesional sclerotherapy using bleomycin. Due to persistent macroglossia, partial reduction glossectomy was done. Conclusion: Lymphangioma is benign vascular lesions that arise from embryological disturbances of the lymphatic system. Management should be multidisciplinary especially in pediatric population. Imaging is essential and management of vital structures should be prioritized. Excision is reserved after conservative measures and life threatening conditions.