Rationale:An epiglottic cyst is a type of benign tumor that is formed due to the obstruction of the mucinous duct and the retention of glandular secretion. In such cases, the glottis is not visible as it is covered by the enlarged epiglottic cyst. When conventional anesthesia is administered in such patients, they might have difficulty ventilation since the epiglottic cyst can easily form a flap and move with external pressure changes and can cause the blockage of the glottis due to the loss of consciousness and the relaxation of the throat muscles of the patient. If endotracheal intubation is not initiated and effective ventilation is not established, the patient may suffer from hypoxia and other accidents.Patient concerns:A 48-year-old male presented to the otolaryngology department with a foreign body sensation in the throat.Diagnoses:A large epiglottic cyst was diagnosed.Interventions:The patient was planned to undergo epiglottis cystectomy under general anesthesia. After induction of anesthesia, the cyst severely covered the glottis and made endotracheal intubation difficult. The anesthesiologist rapidly adjusted the position of the laryngeal lens; thus, the endotracheal intubation was successful under the visual laryngoscope.Outcomes:The endotracheal intubation was successful under the visual laryngoscope and the operation went well.Lessons:Patients with epiglottic cysts are more likely to have difficult airways after induction of anesthesia. Anesthesiologists should take preoperative airway assessment seriously, efficiently handle difficult airway and intubation failure, and make quick and correct choices to ensure patient safety.