Objective To determine the effect of incorporating lingual traction on the success rate of fiberoptic bronchoscope-guided intubation in patients with anticipated difficult airways. Methods In this prospective rando-mized cohort study, 40 adult patients with anticipated difficult airways were enrolled and scheduled for elective surgery. They underwent fiberoptic bronchoscope-guided orotracheal intubation alone (contrast group, n = 20) or with lingual traction by an individual anesthesiologist (experimental group, n = 20) after induction of general anesthesia and neuromuscular blockade. The primary endpoint was the successful rate of the first attempt intubation. The secon-dary outcome was overall successful rate of tracheal intubation. Finally the sore throat grade was observed on the 1st post-operative day. Results Fiberoptic intubation with lingual traction compared to fiberoptic intubation alone resulted in a higher successful rate and greater odds for successful first attempt intubation. The overall successful rate of tracheal intubation in the experimental group was higher than that of the contrast group. Sore throat incidence on the post-operative day 1 was not significantly different between two groups. Conclusions  In this study, lingual traction is shown to be a valuable maneuver for facilitating fiberoptic bronchoscope-guided intubation in the management of patients with anticipated difficult airways.