Awake fiberoptic intubation in a patient with tongue base cancer and limited mouth opening

Awake fiberoptic intubation is a safe and effective technique for anticipated difficult airway management.We present the case of a patient with an infiltrating tongue base tumor, no ventilatory compromise, but significant limitation to mouth opening.Awake intubation was performed using conscious sedation with dexmedetomidine and fentanyl, atropine as antisialagogue, and local anesthesia through combined spray and spray-as-you-go technique.The intubation was successful on the first attempt, without respiratory or hemodynamic complications.The patient remained cooperative and had no recollection of the procedure.This case highlights the utility of a structured protocol, appropriate sedation, and a trained airway team.The approach adhered to current guidelines and demonstrates that awake intubation can be safely performed with excellent tolerance and high success when patient selection is appropriate.