Rosai-Dorfman disease is a rare histiocytic disorder that involves the over-production of non-Langerhans sinus histiocytes. It presents with cervical lymphadenopathy and huge neck swelling that could prove to be a challenging airway and a nightmare for anaesthesiologists. We discuss the airway management of a patient with Rosai-Dorfman disease requiring an emergency tracheostomy as a life-saving measure.