A small sized tube can be used for a patient with tracheal stenosis. However, an ordinary endotracheal tube may be not long enough to pass over stenotic lesion of trachea in adult patient for nasotracheal intubation, when stenotic lesion is located distally. We experienced a patient with severe tracheal stenotic lesion 5 cm above the carina and 3.1 cm length of stenotic lesion scheduled for laryngeal µscopic surgery. The two 4.0 mm tubes-connected tube using modified connector was designed and prepared. We performed fiberoptic-guided awake nasotracheal intubation using the extended endotracheal tube and the patient was successfully managed without complications until the surgery was completed.