Introduction: Surgery usually is the first step and is an important treatment for oral cancer. Because of pre-existing submucous fibrosis, tissue swelling, and distorted anatomic structure, it is very difficult to rapidly intubate endotracheal tube for the airway distress in oral cancer patients. The alternative airways include fiberoptic-assisted nasal endotracheal intubation, cricothyrotomy and tracheostomy necessitate experienced and well-trained specialists enforcement. Consequently, to establish a rapid and effective airway is always a challenge for the on-duty physicians. The aim of this study is to analyze the underlying etiologies of failed airway establishment via root cause analysis and propose the solutions.

Materials and methods: After root cause analysis, establishing an effective transient airway, a briefing information on the sickbed, and well-trained personnel are keys for the successful resusitation. We proposed an alternative transient airway by intubating nasal-epiglottis (NE) airway that was proved to be effective after testing. The distance between NE was measured in thirty-six oral cancer patients by: fiberoptic-assisted measurement (FAM) and magnetic resonance imaging (MRI) or computed tomography (CT).

Results: The average NE distance at FAM, CT, MRI was 17.5 (16–20) mm, 15.8 (14.4–17.5) mm, 15.9 (15.0–17.6) mm, respectively. The difference between the FAM and MRI/CT measurement were 1.6–1.7 mm. The inserted NE airway combined with mouth closure remarkably can retained the 98–100% blood oxygen concentration in all 36 patients.

Conclusion: Therefore, the commercial nasal airway tube, with the length from 14 to 15.5 mm, is prominently unable to establish an effective airway. For the patients with difficult airway, this alternative method may maintain the blood oxygen concentration untill the backup. The education course for the primary care physicians, the disclosure for the difficult airway, standard operation procedure for difficult airway are also the cornerstones for resustating airway emergency.