We describe the first use of an articulating Total Control Introducer (TCI) and video laryngoscope (VL) to guide intubation of a patient with known difficult airway. The patient was an 84-year-old woman with a Mallampati IV airway assessment, small mouth opening, limited neck extension, and micrognathia. We utilized a VL to visualize the glottis and an articulating TCI for endotracheal tube placement. Anteflexion and retroflexion of the introducer tip allowed dynamic navigation through the upper airway and into the trachea. Intubation was performed on first attempt without complications.