Tracheal tube cuff damage usually requires tube replacement; however, in patients with a difficult airway, tube exchange can pose significant risks. We report a case in which cuff damage was successfully managed using an automatic cuff pressure controller. 　The patient was a man in his 70s who was scheduled for posterior decompression and fusion for cervical spondylotic myelopathy while wearing an external spinal fixation device. Awake nasotracheal intubation was performed using a flexible bronchoscope, during which cuff damage was identified. The tracheal tube was exchanged with a Tube Exchanger® but cuff damage recurred, requiring a second exchange using the same method. Although no cuff leak was observed immediately afterward, a gradual decrease in tidal volume developed after repositioning the patient to the prone position. Because the cuff leak was relatively minor, an automatic cuff pressure controller was connected, which maintained tidal volume without further decreases and allowed completion of the surgery. In situations where tube exchange carries high risk, an automatic cuff pressure controller may serve as a temporary rescue measure for cuff damage. The cause of cuff damage in this case was considered to be a nasal septal spur combined with the relatively large tube size.