A patient with recent jaw reconstruction presented for treatment of postoperative oropharyngeal hemorrhage. Asleep nasal fiberoptic intubation was attempted, but a rare and unanticipated complication ensued: rupture of right facial artery pseudoaneurysm. The difficult airway algorithm was followed up to the point of surgical airway. While nasal or oral fiberoptic intubation is often perceived as the safest approach for management of a difficult airway, we discuss alternative treatment strategies for patients with a facial pseudoaneurysm. Such alternatives include preoperative angiographic endovascular embolization of the vessel(s) feeding the pseudoaneurysm, and/or elective tracheostomy.