The method of choice for managing the expected difficult airway is tracheal intubation with an awake patient breathing spontaneously. The CTrach Laryngeal Mask Airway (LMA) is a modified version of the Fastrach LMA that incorporates a fiberoptic system that provides a view of the glottis during ventilation and intubation. We describe 2 cases of intubation in which the CTrach device was used in patients breathing spontaneously. In both cases difficult intubation was foreseen. The CTrach LMA facilitates management of the airway in these circumstances. It is well tolerated and enables a clear view of the airway and permits assisted ventilation when necessary.