Pyriform fossa carcinoma is usually an exophytic squamous cell carcinoma which may lead to a change in the anatomy and pathophysiology of the airway. Total laryngectomy is required in such cases. Airway management is challenging for such patients from both surgical and anesthesiologist's perspective during anesthesia induction. These patients usually present in the advanced stages affecting the surrounding structures, requiring a definite surgical intervention. Management of the difficult airway during the perioperative period is also a difficult task. We are reporting here anesthesia management of a case of right pyriform fossa carcinoma with glottic extension that was posted for total laryngectomy with partial pharyngectomy, right hemithyroidectomy, and bilateral modified radical neck dissection as the lymph nodes were involved. A difficult airway situation was anticipated as a soft tissue growth was crossing the midline covering the glottic opening, involving the aryepiglottic fold and vocal cords as shown on the CT scan.