A 27-year-old female with maxillary maldevelopment was admitted for mandibular sagittal splitting osteotomy with mandibular progeny. General anesthesia was induced with 100 mg of propofol and 8 mg of vecuronium. When a soft and preformed 7.0 mm North-Polar-nasotracheal tube (Portex) was inserted into the nasopharynx through the left nasal cavity, it was very difficult to advance beyond the choana. After nasotracheal intubation, the buking became harder than before when she had been ventilated with a face mask. The peak airway pressure had reached higher than 50 cmH2O with ventilation of 500 ml tidal volume. Bronchoscopy revealed that the fiberscope (3.5 mm O.D.) could not go through the choanal stenosis, because it was too narrow. Therefore, she had to be intubated by a spiral tube, 6.0 mm I.D., through the other nasal cavity with assistance of bronchoscopy, instead of the North-Polar-tube. So, we have to pay attention to the possibility of compression and collapse of a soft nasotracheal tube in the nose of the patient with choanal stenosis due to maxillary maldevelopment.