Subglottic stenosis is a congenital and/or acquired pathology, which can be secondary to prolonged endotracheal intubation and tracheotomy.It is associated with hypoperfusion of the epithelium related to the cuff pressure of the endotracheal tube and/ or the tracheostomy cannula.Grade III-IV stenosis represents urgent and/or emergent airways, which must be managed by expert anesthesiologists who are extensively trained in techniques and algorithms.We report a case of a woman with multiple predictors of difficult airway, obesity and mechanical ventilation due to tracheotomy; with subsequent grade III subglottic stenosis managed with tracheal dilation; who presented a new symptomatic episode, a non-dilatable stenosis of 2 mm and an indication for emergency tracheal reconstruction.