Teratoma in the nasopharynx is one of the rare causes for nasal symptoms in the newborn. The present report was on a term "neonate" who had respiratory distress from a hidden teratoma. Cheaper and readily available investigation modalities including postnasal space X-ray and examination under anesthesia revealed nothing. A postnasal space computed tomography also revealed nothing. Magnetic resonance imaging revealed a mass which was resected endoscopically and histology revealed an immature teratoma. Herein, we present the case, management challenges and literature review to emphasis that negative investigations with persistent nasal symptoms should prompt further evaluation and teratoma should be considered when encountering newborn with nasal symptoms without obvious cause.