This case report describes the challenging airway management in a 50-year-old female patient with squamous cell carcinoma of left buccal mucosa with goiter and hyperthyroidism. The patient presented with a non-healing ulcerating growth on the left cheek and required Commando Surgery. Traditional airway management methods such as bag-mask ventilation and tracheostomy were not viable due to edematous larynx presence of a large goiter. Initial attempts at awake fiberoptic intubation were unsuccessful due to swelling in the vocal cords. The patient received anti-inflammatory medications to reduce the swelling and subsequently
underwent successful nasal intubation. The surgery was completed without complications, and the patient was extubated after 48 hours. This case emphasizes the importance of meticulous airway planning and the use of alternative techniques in patients with limited mouth opening and airway abnormalities.