In this article, we report a case describing the airway management and anesthetic technique of a 47-year-old male patient undergoing endolaryngeal surgery with extremely limited mouth opening due to previous maxillofacial trauma. An excisional biopsy was planned after laryngoscopic examination for a possible pathological right vocal cord irregularity. Anterior open laryngofissure approach under transtracheal high-frequency jet ventilation was performed after reviewing all possibilities. Neither direct laryngoscopy nor any endolaryngeal instrument placement was possible in this case. This approach was considered the most preferable choice to provide an unobstructed surgical field and safe gas exchange without requiring additional invasive procedure.Keywords: Difficult airway, laryngofissure approach, transtracheal high-frequency jet ventilation.