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Journal of Craniofacial Surgery· 2026Q2· Case report

Oral to Nasal Endotracheal Tube Exchange in a Difficult Airway Patient During Maxillofacial Surgery

Siwen Zhao, Chao Wen, Xiaoshuang Guo, Dong Yang

Short summary

A hybrid video laryngoscopy and fiberoptic bronchoscopy (FOB) technique successfully facilitated a 5-minute oral-to-nasal endotracheal tube exchange in a patient with Crouzon syndrome and a difficult airway during maxillofacial surgery.

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Abstract

This case report describes a successful oral-to-nasal endotracheal tube exchange using a combined video laryngoscopy and fiberoptic bronchoscopy (FOB) technique in a 48-year-old patient with Crouzon syndrome following modified Le Fort III osteotomy and Le Fort I osteotomy. Severe midfacial disruption, bleeding, and secretions precluded the use of FOB alone. The video laryngoscope provided a continuous glottic view and enabled suctioning, while guiding the FOB into the trachea alongside the existing tube. The exchange was completed smoothly within 5 minutes without desaturation. This hybrid approach is an effective strategy for managing difficult airway exchange in complex maxillofacial surgery.

The authors' abstract, as published at the source. Journal of Craniofacial Surgery, 2026 · DOI ↗

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Field: Anesthesiology and Pain Medicine

Anesthesiology and Pain MedicineMedicine