Periglottic masses can be treated by laser excision, simple electrocautery, or wide excision, including neck dissection. Smooth induction of anesthesia and airway management is a challenge in these patients.There is limited published literature on the probable airway complications during anesthetic induction with significant variability and low predictability among patients. We report one case of unexpectedly severe ventilatory difficulty in a patient who developed recurrent vocal cord cancer. Through the analysis of this case, we stress the limitations of clinical prediction of airway compromise during anesthetic induction and discuss the usefulness of a video laryngoscope in this kind of emergency.