Large thyroid tumors present distortion of the airway, endocrine disturbance and metastatic effect. It may compromise airway directly or indirectly through dysfunction of the recurrent laryngeal nerve. The management of abnormal airway structure and the potential for both difficult intubation and surgical access to the airway are based on the principle of burning no bridges. Thyroidectomy can be performed under regional anesthesia using cervical epidural anesthesia in which maintenance of the airway and monitoring of recurrent laryngeal nerve function are possible. We describe a patient in whom a large thyroid mass with marked tracheal deviation was treated successfully by cervical epidural anesthesia and spontaneous respiration.