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Noonan Syndrome is an autosomal dominant congenital syndrome that is a multisystem disorder, commonly presenting with craniomaxillofacial, cardiac, and hematologic differences. Anterior mandibular surgery presents a surgical challenge because of potential injury to vessels in the floor of mouth. Inadequately-controlled hemorrhage, particularly in the setting of coagulopathy, may quickly escalate to acute airway obstruction. Additionally, modest hypotension maintained under general anesthesia typically reverses upon wakening, potentially resulting in refractory hemorrhage. In this report, we document a case of rapidly evolving floor of mouth elevation secondary to hemorrhage following alveolar symphyseal reconstruction in a patient with Noonan syndrome. Early recognition and operative re-exploration for hemorrhage control, with airway control, administration of high-dose intravenous steroid, and close monitoring in the intensive care unit resulted in rapid resolution of mouth-floor swelling, safe extubation, and a successful surgical outcome. Keywords: Sublingual hematoma, Noonan syndrome, Intraoral hemorrhage, Coagulopathy, Airway management