Accidental Endotracheal Tube Compromise During Genioplasty: An Anesthetic and Surgical Challenge.

Airway security is critical in maxillofacial surgery, where operative procedures are performed in close proximity to the airway. Although genioplasty is considered a safe adjunct to orthognathic surgery, inadvertent endotracheal tube (ETT) damage during osteotomy is a rare but potentially life-threatening complication. A 22-year-old male with skeletal Class III malocclusion underwent combined orthognathic surgery with genioplasty under general anesthesia. During the genioplasty osteotomy, the ETT was partially transected, resulting in an acute airway emergency. The complication was promptly recognized through changes in ventilation parameters, and coordinated intervention by the anesthetic and surgical teams enabled successful airway control and tube replacement without adverse sequelae. Intraoperative ETT injury during genioplasty is an uncommon but serious event. Early recognition, effective communication, and a well-coordinated multidisciplinary response are essential to prevent catastrophic airway compromise and ensure patient safety.