Awake fiberoptic nasotracheal intubation is usually performed in patients with an anticipated difficult airway. For patient comfort, it's important to provide adequate level of sedation. In this case, we discussed our experience with the literature about usage of dexmedetomidine in nasotracheal awake fiberoptic intubation for the expected difficult airway in a patient with bilateral temporomandibular joint ankylosis and limited mouth opening who was planned to deformity repair under general anesthesia.