Difficult nasotracheal intubation: a previously unreported anatomical cause.

Anatomic and congenital abnormalities of the nasal pharynx may make nasotracheal intubation difficult. We present a case of a patient who was comatose from a drug overdose and who required endotracheal intubation. Blind nasotracheal intubation was attempted and was initially unsuccessful due to the presence of a congenital pharyngeal bursa. After the cause of the obstruction was recognized, guided nasotracheal intubation was accomplished without complications. The patient made an uneventful recovery.