• Yanwei Zhang, Xiang Lv, Pingping Sun, and Dekun Yin.
• Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• Medicine (Baltimore). 2023 Apr 21; 102 (16): e33584e33584.

BackgroundSevere mouth opening difficulty may increase the risk of airway management during anesthesia induction, and awake fiberoptic nasotracheal intubation (AFNI) is the first option for patients with orofacial anatomical changes.Case SummaryA 54-year-old man was scheduled to undergo wedge resection of the right upper lung in August 2021. The patient had a history of enlarged right maxillary lesion resection and partial right maxillary resection surgery in April 2020, which led to orofacial anatomical changes and severe mouth opening difficulty. To avoid difficult airway-related emergency scenarios, the AFNI was successfully performed through intravenous injection of sufentanil and dexmedetomidine combined with lidocaine topical anesthesia under a conscious state without any uncomfortable feeling or complications.ConclusionsIntravenous injection of sufentanil and dexmedetomidine combined with lidocaine topical anesthesia can be used as an alternative medication scheme to relieve uncomfortable suffering for AFNI in patients with severe mouth opening difficulty.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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