The American Society of Anesthesiologists defines a difficult airway as the clinical situation in which a conventionally trained Anesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both.5 Retrograde intubation, among other invasive back-up techniques such as cricothyroidotomy, should be considered in any patient in whom endotracheal intubation may be difficult, is contraindicated, or has failed. It is potentially indicated when airway control is required and less invasive methods have failed. Maxillofacial trauma and cervical spine fractures represent the most common etiologies of a difficult airway.6 In one report of 19 patients with either maxillofacial trauma or fractures of the cervical spine, six had prior, failed orotracheal intubation attempts. In all of these patients, retrograde intubation was successful on the first attempt.6 Jaw ankylosis, cervical arthritis, mouth tumors, and muscular dystrophy represent less common but equally challenging airway situations.4,7