We present a case of 65 year old man with carcinoma larynx who was tracheostomised and presented to emergency room with difficulty in breathing. He was habituated to changing the tracheostomy tube himself. In doing so one morning he found the tracheostomy tube missing after a violent bout of cough, with only the flange left behind in his hand.

RESULTS : Patient was successfully managed with bronchoscopy under local anesthesia. The patient was nebulized by 2% Xylocaine and 3 ml of 2% Xylocaine solution was instilled through tracheotomy stoma. After waiting for 5 minutes a rigid bronchoscopy was attempted. The fractured tracheotomy tube was visualized and grasped with forceps, however, it lost grip. The bronchoscope was then taken out. Tracheostomy tube caught with an artery forceps and pulled out.

CONCLUSIONS : Fracture and aspiration of tracheostomy tube is a rare complication which requires a prompt and precise management. Patient education regarding the maintenance of tracheostomy tube for prevention of this complication is highly recommended. Bronchoscopy under local anesthesia is a safe method to remove aspirated tube.