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Oral and maxillofacial surgeries associated with complications due to endotracheal tube (ETT) damage are being reported in literature increasingly. In this case, we report a rare case of accidental perforation of a flexometallic ETT intraoperatively during an orthognathic corrective surgery, in a 19-year-old female patient in whom submental intubation had been performed. The complication was managed conservatively as the tissue debris created during the osteotomy drilling occluded the damage and caused a good seal of the damage, with minimal leak, and no airway compromise. The purpose of this article is to highlight these hazards and discuss alternative airway management approaches so that anesthesiologists can recognize these complications and be prepared to deal with them in a proper manner. [ABSTRACT FROM AUTHOR]