The fetus presenting as a patient has now become a reality for the majority of clinicians. The evolution of imaging techniques has dramatically increased our knowledge of embryology and presented surgeons from all specialties with new challenges. There can be no doubt that at some point in our surgical career we will be faced with a fetal patient. Our work will provide great insight into the rapidly evolving world of fetal medicine and arm the surgeon to guide the management of the fetus and their family. We present the fascinating case of a prenatal glioma, which we managed at our tertiary centre after diagnosing at 20 weeks gestation. Such craniofacial malformations present multiple challenges and the maxillofacial surgeon is a key member of the multidisciplinary team which must provide counselling, differential diagnosis, genetic screening, safe delivery and ultimately appropriately timed surgical management. We discuss craniofacial malformations which are increasingly being detected prenatally and review new methods to ensure safe delivery of children born with potential airway compromise. Finally we discuss the potential differential diagnosis which are pertinent to prenatally detected craniofacial lesions, the indications and timing of surgical management of these craniofacial malformations.

Conflict of interest: None declared.