Endolaryngeal microsurgery is a well-established procedure, with proper laryngeal exposure is critical for success. However, there are instances where achieving complete visualization of the laryngeal inlet, particularly the anterior commissure, can be challenging, termed as difficult laryngeal exposure (DLE). The Laryngoscore, introduced in 2014, can accurately predict DLE and assist in preoperative planning. We report a case of DLE encountered during transoral laser microsurgery in a 50-year-old obese woman with bilateral vocal fold paralysis following total thyroidectomy and describe the maneuvers applied, which led to successful surgery. This case underscores the importance of the role of Laryngoscore in preoperative assessment and discusses the useful maneuvers in managing DLE.