A Novel Nebulization–Assisted Topicalization Device for Flexible Bronchoscopic–Guided Awake Nasotracheal Intubation: A Case Report

Awake flexible bronchoscopic (FB)-guided nasotracheal intubation is often necessary for managing difficult airways, especially in maxillofacial surgeries. We present 2 cases used a novel device for airway topicalization with a local anesthetic (LA) solution. This device integrates a nasal trumpet with a nebulization chamber to deliver 4% lidocaine, effectively anesthetizing the nasal cavity, nasopharynx, and the vocal cords. This technique was successfully used in 2 patients, ensuring smooth and efficient awake FB-guided nasotracheal intubation while minimizing adverse effects such as epistaxis, coughing, or discomfort.