A 23-year-old male patient with cervico-occipital fixator was scheduled for surgery due to injuries to the right forearm. The patient s thyromental dis- tance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. The loss of extension of the neck in particular indica- ted difficult intubation. Anaesthetic procedures are almost always difficult in patients with cervico-occipital fixators; the limited cervical extension complicates both intubation and ventilation. In this report, application of general anaesthesia using awake fibre-optic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedica- tion, hypopharyngeal topical anaesthesia was applied with 10% lidocaine sprayed twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following comp- letion of local anaesthesia, the patient, who was oxygenated with 5 L min-1 of 100% O2, was intubated using the awake FOB technique. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of cervi- co-occipital fixation, which causes severe limitation of neck movements, the use of awake fibre-optic intubation should be considered.