The Difficult Airway Society (DAS) has guidelines for managing difficult airways, though these primarily address general scenarios rather than specific cases such as neck malignancies. In this report, we aim to highlight the pivotal role of Point-of-Care Ultrasound (POCUS) in managing difficult airways due to a neck tumor. We present a case involving a 43-year-old female with a neck tumor measuring 25 cm in diameter, who presented with shortness of breath. We used POCUS as a guide to accurately locate the shifted trachea before performing a surgical tracheostomy (ST). Despite multiple failed attempts at intubation, the tracheostomy was successful and resulted in a positive outcome. In conclusion, the use of POCUS plays a lifesaving role in managing difficult airways. Its training should be mandatory for medical professionals and more widely implemented in clinical practice, particularly for tracing anatomical alterations of the trachea and other structures shifted by neck malignancies.