Focused Nebulization for Awake Fibreoptic Nasotracheal Intubation in a Severely Distorted Upper Airway: A Case Report.

Awake flexible bronchoscopic (FB) nasotracheal intubation is recommended for anticipated difficult airways, but its success depends on effective airway topicalization. We report a case of a patient with a severely distorted upper airway due to a maxillary tumor, where conventional topicalization techniques were impractical. Directed nasal nebulization of lidocaine using an uncuffed endotracheal tube (ETT) as a conduit, supplemented with spray-as-you-go (SAYGO) anesthesia and dexmedetomidine sedation, facilitated successful awake intubation. This case demonstrates the applicability of directed nasal nebulization in complex airway anatomy when alternative topicalization strategies are limited.