Prenatal diagnosis of fetal facial and neck tumors, especially in the first trimester, is challenging due to their rarity and variability. Advances in high-resolution ultrasound and routine first-trimester screening for aneuploidy have improved the detection of orofacial masses, allowing early detection and surveillance. This case report describes a 27-year-old primigravida who was found to have a heterogeneous mass in the fetal facial region at 12 weeks’ gestation. Initial differential diagnoses included epignathus, epulis, or hemangioma. Subsequent detailed ultrasound examinations confirmed the localized, noninvasive nature of the mass. Follow-up examinations revealed a spontaneous reduction in size without affecting neighboring structures. Postnatal findings were consistent with prenatal imaging and showed a benign, cystic lesion. This case underscores the value of early ultrasonography in the detection and surveillance of fetal anomalies and highlights the importance of individualized counseling and follow-up to determine outcome and effective prenatal and postnatal management.