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

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.