Nasotracheal intubation from two weeks to 40 months of age and its effect on communication are described. The treatment program for this patient with the condition of asphyxiating thoracic dystrophy included four surgical procedures to expand her rib cage and positive pressure ventilation to subserve respiration. The positive pressure ventilator was connected to a nasotracheal tube. The results of laryngeal examinations are discussed, as is the patient’s development of language and speech. The prolonged use of nasotracheal intubation had minimal consequences on the vocal folds and the development of language and speech.