Background: Aim: Prediction of difficult intubation remains a key challenge in airway management. Unanticipated difficult intubation in patients with apparently normal airways represents the most dangerous airway scenario in anaesthetic practice, as conventional bedside predictors are often subjective and unreliable. While existing literature has largely focused on anticipated difficult airways, objective tools for the unanticipated setting remain limited. Ultrasonographic airway assessment offers a promising objective alternative. This study aimed to evaluate the correlation between ultrasonographic airway measurements and Cormack–Lehane (C–L) grading in patients with no obvious preoperative predictors of difficulty, and to compare their predictive accuracy with conventional clinical methods. Materials and Methods: This prospective observational study included 189 ASA I and II patients aged 18–60 years undergoing elective surgery under general anesthesia. Preoperative assessment included Modified Mallampati score, thyromental distance, upper lip bite test, and ultrasonographic measurements of distance from skin to epiglottis (DSE) and hyoid bone (DSHB). Direct laryngoscopy was performed by blinded anaesthesiologists, and C–L grading was recorded. Statistical analysis included correlation, ordinal logistic regression, and ROC analysis. Results: Difficult laryngoscopy (C–L Grade III/IV) was observed in 10% of patients. A strong correlation between DSE and DSHB was noted in Grade III cases. DSE emerged as the most significant predictor, outperforming conventional airway assessments. A DSE cut-off of 1.8 cm showed optimal diagnostic performance. BMI was significantly associated with difficult intubation, while TMD indicated easier laryngoscopy. ROC analysis demonstrated excellent predictive ability (AUC = 0.88). Conclusion: Ultrasonographic airway assessment, particularly DSE, is a reliable and objective predictor of difficult intubation. Its incorporation into routine