Laryngeal mask airway (LMA) was designed as a new concept of airway management in anesthetic practice and has been successfully used in patients with difficult endotracheal intubation due to an abnormal upper airways. When It is in good position, one can cannulate the trachea either blindly or fiberoptic brochoscopically. In a patient with short neck and large breast, we were forced to use an emergency LMA because couldn't insert the laryngoscope. We decided to replace the LMA with an endotracheal tube to secure a definite airway. A fiberoptic bronchoscope was passed through both the endotracheal tube and the LMA to achieve endotracheal intubation. Then we attempted to remove the LMA for safe and smooth awakening. But the LMA coudln't be removed while keeping the LMA and the endotracheal tube in position. Therefore, surgery had to be proceeded with both the LMA and the endotracheal tube in place and all of which were removed after the surgical procedure. We conclude that the LMA is very useful as an aid of endotracheal intubation in patients with difficult airway.