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Airway management in patient with ankylosis TMJ(temporomandibular joint)produce a challenging situation.The development technique to overcome this situation has evolved from blind nasal intubation,retrogard intubation using a guide wire,and fiberoptic naso-tracheal intubation.A-19th year old male-patient(50 kg,165 cm,ASA physical status Ⅰ),diagnose with ankylosisTMJ,plan to performed jaw reconstruction under general anesthesia.Airway examination shows difficulty in mouth opening,revealed the mouth opening only 0,5 cm.Both nares were patent and the neck mobility was normal.There were no history of hoarseness of voice,breathlessness and difficulty of swallowing,nor frequent sleep awakening at night.We planned to performed naso-tracheal intubation using fiberoptic.Explanation of the procedure were given to the patient,and informed consent was obtained In the first attempt,we gave thiopental as sedation and performed fiberoptic naso-tracheal intubation,this attempt was failed due to bleeding of the concha while trying to insert the fiberoptic through the nostril and the blood covered the fiberoptic so no clear visual.Second attempt,the first trick was to give a proper informed consent to the patient about the procedure to calm the patient.Second trick,we nebulize the patient with lidocaine 10% 2 mg/kg and atropine.Third trick,we put a pack in the nostril with adrenaline 1∶200.000 bilaterally for 5 minutes,and the forth trick,swipe the tip of the fiberopticwith soap water to prevent condensation and improve visualization.We can also darkened the operating room to help better visualization.To remove air bubble we dont use normal saline spray but instead we used air to reduce intraoral liquid.Using this tricks,the intubation was successful.The management for difficult airway has been evolved throughout the years.The use of fiberoptic naso-tracheal intubation was the best method used in this case.Our patient presented with ankylosis TMJ with 0.5 cm mouth opening present a challenge in managing airway.The use of fiberoptic naso-tracheal intubation without an adequate preparation despite the skillful of the anesthesiologist can cause its own difficulty.A view tricks presented here,we used the term ILAS(informed consent,Lidocaine,Adrenalin,Soap water),proven can help make difficult airway management better.It can be concluded that the successful in naso-tracheal fiberoptic intubation were not only lies in the skill of the anesthesiologist but also an adequate preparation.The tricks term as ILAS may help a better outcome in patient with ankylosis TMJ underwent fiberoptic naso-tracheal intubation.