Patients with present or previous history of facio-maxillary trauma will mostly be associated with a difficult airway. Surgical correction of these injuries might not always correct the altered airway. We report a case of palatonasal fistula following an old facio-maxillary fracture, which has led to interpretation of a difficult airway into a normal one. The patient was found to be having difficult airway during direct laryngoscopy which caused failure to intubate initially. Though, the patient was successfully intubated in the third attempt by senior anaesthesiologist making use of manoeuvres and equipment available, it made an impact for us to do a proper pre-op evaluation of patients with history of surgical correction of facial injuries and also for being prepared for can't ventilate and can't intubate situation in such type of cases. Through, this case report we stress the importance of airway anatomical alterations following facio-maxillary trauma and their corresponding management.