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Iatrogenic tracheal injury is a rare complication after endotracheal intubation. Mucosal injury should be identified, and it is important to rule out pneumomediastinum and pneumothorax. The diagnosis is based on clinical and endoscopic findings and chest computed tomography. Broad-spectrum antibiotics should be given to avoid mediastinitis. We report a patient with a 5 mm tracheal laceration and significant subcutaneous emphysema after endotracheal intubation. The true incidence of this complication is unknown and early recognition warrants better outcomes.