At a rural district hospital in Burundi, a 3-year-old severely malnourished girl with Noma presented to the operating room for placement of a gastrostomy tube. The child had a large left-sided facial defect as well as trismus. After induction of general anesthesia, the anesthesia provider was unable to open her mouth. Given that the hospital has no fiberoptic bronchoscope, direct laryngoscopy and intubation were performed directly through her facial defect. After securing the airway, the surgery proceeded without difficulty.