 Nasotracheal intubation is often used for intraoral surgery. However, it can be difficult if the patient has a deviated nasal septum or a narrow nasal cavity. In this case, the patient had both issues, which led to repeated endotracheal tube cuff tears during nasotracheal intubation. The surgeon then reintubated the patient through the other nasal cavity without any further complications. Additionally, the surgeon discovered that one of the orthodontic microimplants placed in the middle of the endotracheal tube was exposed to the nasal cavity, which could have caused the cuff tears. This highlights the importance of preoperative evaluation of the patient's anatomy and the potential risks associated with certain procedures. This article was authored by Suhyun Seo, Junim Oh Lee, Jei Jin Lee, and others.