Background: Airway management in patients with zero or severely restricted mouth opening presents a significant challenge to anesthesiologists. Conventional intubation techniques are often not feasible, increasing the risk of airway-related complications. Awake fiberoptic intubation (AFOI) is considered the gold standard in such cases, as it allows secure airway management while maintaining spontaneous ventilation. Case Presentation: We report the case of a 33-year-old male, Mr Jitendra Kumar, with markedly restricted mouth opening, scheduled for surgery under general anaesthesia. Anticipating a difficult airway, a planned awake fiberoptic intubation was performed. After obtaining informed consent and thorough preoperative counselling, the patient was prepared with standard monitoring, antiseptics, and carefully titrated sedation. Adequate airway anaesthesia was achieved using a combination of supralaryngeal (superior laryngeal nerve) block and transtracheal block. Fiberoptic intubation was successfully performed with the patient awake and cooperative, maintaining stable hemodynamics throughout the procedure. Considering the anticipated difficulty in reintubation and risk of airway oedema, a decision for elective extubation was made, and the patient was managed in a monitored setting until safe extubation. Conclusion: This case highlights that awake fiberoptic intubation remains the safest and most effective technique for airway management in patients with severely restricted mouth opening. Successful outcomes depend on meticulous preoperative planning, effective patient communication, adequate airway anaesthesia using nerve blocks, and careful postoperative airway management, including consideration of elective extubation.