When faced with an anticipated difficult airway, we need to consider securing the airway in an awake state without using anaesthetic agents and muscle relaxants. Awake fiberoptic intubation is a non- invasive technique of securing airway in such patients. This case resport discusses the anesthetic management of a 28 year old man with Oral Submucous Fibrosis where tracheostomy was avoided with the use of awake fiberoptic intubation. Awake fiberoptic intubation under topical anesthesia may be the ideal method to secure the airway in advanced cases of Oral Submucous Fibrosis. As the procedure can be highly discomforting, the patient has to be prepared psychologically and pharmacologically for awake intubation. When fiberoptic bronchoscopy is not feasible, not available or has failed, an awake tracheostomy may be the preferred option.
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