Nasotracheal intubation can reveal unexpected findings like a foreign body in the airway. In such instances, expeditious decision-making is crucial to achieve ideal outcomes. This case report describes a petroleum jelly–based foreign body discovered in the nasopharynx during nasotracheal intubation and the subsequent airway management. A 64-year-old man with no prior history of adverse anesthetic events presented to an oral surgery office for extraction of teeth and placement of implants. While video laryngoscopy for nasotracheal intubation was performed, a blue foreign body was discovered inside the tip of the nasal endotracheal tube. Subsequent attempts to locate the source of the foreign body revealed in the nasopharynx a strip of blue gelatinous foreign body which was removed with suction. Due to the persistent presence of foreign body residues in the nasopharynx, orotracheal intubation was performed. Nasopharyngeal foreign bodies may elude even the most thorough preoperative medical history review and airway assessment. Therefore, it is reasonable for practitioners to ask explicitly about any foreign bodies in the nasal passages. Practitioners should become familiar with cognitive aids for relevant airway emergency management techniques and equipment for expeditious decision-making when unexpected foreign bodies are found.