We report an experience with difficult airway management due to unexpected laryngeal deformities. A 69-year-old man who had been diagnosed with left vocal cord paralysis was scheduled for eye surgery. After the induction of anesthesia, mask ventilation was inadequate and intubation was impossible, so an emergency tracheostomy had to be performed. In the larynx examination, the left vocal cord was paralyzed close to the midline and the left corniculate tubercle was enlarged and partially blocked the rima glottidis. Laryngeal deformities may cause unexpected difficult airway management. Clinicians always have to pay close attention to the potential risk and prepare for emergency situations including an invasive approach to the airway.