Hard to Swallow: Tongue Avulsion Secondary to Hypocortisolism Posing a Difficult Airway.

Maxillofacial trauma involving tongue injuries poses a significant challenge for airway management due to active bleeding, anatomical distortion, and the risk of obstruction and aspiration. We report the case of a 37-year-old man who presented with a self-inflicted tongue avulsion, likely in the context of an epileptic seizure. The patient was orotracheally intubated and transferred by helicopter under sedation and mechanical ventilation to a tertiary center, where the surgical team requested nasotracheal intubation to facilitate intraoral access. However, active bleeding and avulsion of tongue segments posed a high risk of complications, so it was decided to reposition the existing orotracheal tube under continuous suction and videolaryngoscopic guidance. This case highlights the importance of tailoring anesthetic and airway strategies to the specific anatomical and surgical context, underscoring the need for targeted simulation training in maxillofacial airway management.