J Dent Anesth Pain Med.  2018 Apr;18(2):125-128. 10.17245/jdapm.2018.18.2.125.

Orotracheal intubation in a patient with difficult airway by using fiberoptic nasotracheal intubation: A case report

  • 1Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea. stone90@snu.ac.kr


In cases of a difficult intubation where numerous intubation methods, including laryngoscopy, have failed, yet oral intubation is still necessary, the method of tube exchange after fiberoptic nasal intubation may be attempted. Fiberoptic nasal intubation allows intubation to be performed relatively easily when the laryngeal view grade is poor. We report a case in which our attempt at oral intubation for total maxillectomy with laryngoscopy and fiberoptic oral intubation had failed due to an unexpected difficult airway; subsequently, we successfully completed the surgery by performing fiberoptic nasal intubation to secure the airway, followed by using a tube exchanger to exchange to an oral endotracheal tube.


Difficult Intubation; Endotracheal Tube Exchanger; Fiberoptic Nasal Intubation

MeSH Terms



  • Fig. 1 The patient showed a thyromental distance of 3.3 cm. A short thyromental distance (< 6 cm) is associated with difficult intubation.

  • Fig. 2 (A) The nasal RAE tube was inserted. (B) After inserting the tube exchanger through the nasal RAE tube, the nasal RAE tube was removed. (C and D) The tube exchanger is taken out through the mouth with a direct laryngoscope and Magill forceps. (E) The tube exchanger was taken out through the mouth. (F) The oral RAE tube was inserted through the tube exchanger. (G) The oral RAE had been inserted successfully.


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