<p>  In the management of patients with cleft lip and palate necessitating orthognathic surgery to address jaw deformities after a pharyngeal flap procedure, challenges may arise during nasal intubation. These challenges can result in damage to the pharyngeal flap and hinder the placement of a tracheal tube. This report describes a case of 22-year-old man who was scheduled to undergo bilateral sagittal split ramus osteotomy following a pharyngeal flap procedure aimed at ameliorating nasopharyngeal obstruction dysfunction. Before planned surgery, an assessment conducted at our otorhinolaryngology clinic unveiled adhesions between the right inferior nasal turbinate and the nasal septum, rendering nasal intubation through the right nasal cavity unfeasible. Consequently, the patient underwent a two-step intubation procedure. First, oral intubation was performed to ensure airway maintenance, followed by the insertion of a nasotracheal tube through the left nasal cavity, guided by bronchoscopy, directing it towards the left-side pharyngeal flap orifice. If nasal intubation proved to be impracticable or effective respiratory management became difficult, the contingency plan entailed terminating the surgical procedure without resorting to submental endotracheal intubation or tracheostomy. Given the frequent involvement of dental anesthesiologists in cases where nasal intubation is required after pharyngeal flap surgery, it is of paramount importance to proactively mitigate the risk of pharyngeal flap damage. This involves a comprehensive preoperative assessment and simulation utilizing imaging and nasopharyngeal endoscopy, in addition to devising multiple intubation strategies and validation techniques for ascertaining the integrity of the pharyngeal flap based on established protocols and prior research findings.</p>