A potential hazard of orthognathic surgery is disruption to the endotracheal tube as it passes through the nasal cavity. Instrumentation necessary to the surgical procedure can inadvertently sever the tube either partially or completely necessitating one of several procedures to correct the situation. A case report is presented which describes a situation where the patient's endotracheal tube had been partially lacerated intraoperatively. Due to lack of patency in one nostril, a method for replacement was required that allowed the new tube to pass through the same nostril as the original tube without placing excessive forces on a surgically fractured maxilla. The mechanism for the replacement procedure as well as consideration of alternative approaches is discussed.