• Seyyed Hassan Etemadi, Amir Bahrami, Ali Mohammad Farahmand, and Mohammad Mahdi Zamani.
• Department of Anesthesiology, Hazrat Fatemeh Medical Center, Iran University of Medical Sciences, Tehran, Iran.
• Anesth Pain Med. 2015 Dec 1; 5 (6): e29299.

IntroductionPatients with mandible deformity may die, as a result of airway management failures. The awake nasal fiberoptic intubation is known as the optimum intubation method, in the mentioned patients, although, in several cases, fiberoptic intubation fails.Case PresentationThe present case discusses a patient with severe deformity of mandible that was admitted for correction with free-flap. The following intubation techniques were used for her airway management, respectively: blind awake nasal intubation, awake oral fiberoptic and awake nasal fiberoptic, which failed all. We therefore decided to perform awake nasal intubation, with fiberoptic, in sitting position.ConclusionsIn this case, after failure of awake fiberoptic intubation, awake direct laryngoscopy and blind nasal intubation, finally awake nasal intubation in sitting position, using fiberoptic led to success.

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