A 60-year-old patient after laryngectomy and bilateral neck dissection. A 5 cm TML into the right main bronchus with a broad communication with the mediastinum occurred during intubation for an abdominal operative intervention. Even though no air leak and no pneumothorax was present, the indication for operative repair was crucial because the patient needed permanent tracheostomy and dislocation of the tip of the tube into the mediastinum occurred postoperatively while moving the neck