The incidence of airway difficulty in the general surgical population varies greatly depending on the degree of airway difficulty. Much of the anesthesia related morbidity attributable to managing a difficult airway comes from an interurruption of gas exchange (hypoxia and hypercarbia) which may cause cardiovascular instability and brain damage. Most airway catastrophes ocurrs when possible difficulty with the airway was not recognized. Although fiberoptic intubation is reliable method in patients with difficult airways, there are many cases of difficulty in visualizing the structure of the larynx with conventional fiberoptic technique due to copious secretion, swelling and hemorrhage in the pharyngeal cavity. Recently, we experienced a success in difficult tracheal intubation with LMA in the 27 year old male patient diagnosed ankylosing spondylitis. We hope that using a #4 LMA as a conduit for 6.0 mm cuffed endotracheal tube with the aid of fiberscope attached to the video camera system would be an alternative method for difficult intubation.