A patient with obvious difficult airway who was received awake tracheal intubation using combination of an Airtraq (R) optical laryngoscope with smartphone and video flexible endoscope posted for elective surgery of tonsillectomy for OSAHS was reported. Our experiences strongly indicate that fully communication with patients, detailed preoperative assessment of airways and perfect plan, appropriate endotracheal intubation approach and devices play important roles in awake tracheal intubation in difficult airway.