Ryles tube-guided difficult nasal intubation

Rationale: Nasal intubation is an inevitable procedure in head and neck and oral cavity surgeries. Most of these patients usually present with distorted oral and nasal anatomy. Patient Concerns: The distorted anatomy in these patients makes their airway difficult and there are high chances of nasal bleed while securing the airway nasally. Diagnosis: Ryle's tube guided nasal intubation in a patient with temporomandibular joint derangement posted for bilateral temporomandibular joint arthrocentesis. Interventions: After induction of anaesthesia, we faced difficulty in passing North Pole tube via nasal passage, hence we rail roaded the North Pole tube over a Ryle's tube and successfully secured the airway. Outcomes: This innovative method helped us to secure the airway in this patient. Lessons: This simple technique of using a Ryle's tube as an aid for nasal intubation provides an alternate technique for difficult nasal intubation. Although it may not be the first choice for nasal intubation, this technique can be used as an alternative method in case, the tube could not be negotiated through the nasal passage.