INTRODUCTION: Cervical lymphatic malformations in children rarely present with acute airway compromise. During an acute exacerbation or hemorrhage, lymphatic malformations involving the deep neck spaces may precipitate critical airway obstruction. These are rare clinical entities and tracheotomy is the standard procedure to bypass impending airway obstruction. METHODS: We present our recent experience with 2 children presenting with acute airway compromise resulting from deep space cervical lymphatic malformations and describe our technique and success with transoral sclerotherapy. RESULTS: Direct laryngoscopy-assisted transoral sclerotherapy with doxycycline may be considered an alternative to tracheotomy to address retropharyngeal and parapharyngeal space lymphatic malformations. CONCLUSIONS: Direct laryngoscopy-assisted transoral sclerotherapy is an excellent treatment option for children with deep space cervical lymphatic malformations with airway compromise. It is effective, provides direct access, and can be an alternative to a tracheotomy.