This case demonstrates how difficult it can be to predict in which patients endotracheal intubation will be difficult, even when they have been assessed using the numerous criteria reported. The epiglottis must not be overlooked as one of the factors which can cause difficulty with intubation. Since there is certainly not one cause for all difficult intubations, airway assessment must be as comprehensive as possible, while producing the least risk to the patient. In this regard, MRI offers a unique tool in that it is not invasive and produces no ionizing radiation exposure, yet it provides excellent detail of airway structures. For these reasons, MRI provides the means for prospectively and retrospectively assessing the difficult airway.