Conclusions

Intraoperative ETT injury during genioplasty, though rare, can progress rapidly to a life-threatening airway emergency. This case reinforces that early recognition through continuous capnography, disciplined communication between the surgical and anesthetic teams, and immediate readiness for tube exchange are decisive in averting harm. Equally important, the complication is largely preventable: shielding the submental tube segment, confirming its position before osteotomy, and considering piezoelectric instrumentation should be routine safeguards in shared-airway surgery. As a single case report, these observations are limited in generalizability, but they provide a practical framework for anticipating and mitigating a complication that is easily overlooked until it occurs.