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A 3-year-old girl with Pierre Robin Syndrome, having complaints of respiratory distress in supine position and disturbance during sleep due to airway obstruction, was scheduled for adenoidectomy. After ensuring all available precautionary measures along with facilities for emergency tracheostomy, gas induction without muscle relaxation was done in a posture at where her respiratory distress was least. The glottis could not be visualized by direct laryngoscopy in any way. Consecutive three attempts were failed and intubation was successful on fourth attempt with a gum elastic bougie. Then after curarisation, adenoidectomy was performed. Five teeth were avulsed during the instrumentations, 4 out of 5 could be recovered. Fluoroscopic screening located the 5th tooth in right main bronchus. The patient was reversed and kept on spontaneous breathing with ETT in situ. On 1st POD, gas induction was done for removal of the lost tooth. ETT was removed and with muscle relaxation, rigid bronchoscopy was attempted without success. Repeated attempts were made with intermittent ventilation and at one stage bag-mask ventilation became impossible with sharp fall of SpO2 , even down to zero for a while. Emergency tracheostomy was asked for and a needle cricothyroidectomy was done immediately. The patient had a period of anoxia during establishment of safe airway through tracheostome. After ensuring a safe airway through tracheostomy and stabilization of her vital parameters, rigid bronchoscopy was performed through tracheostome and the tooth was removed. Adequate spontaneous ventilation was achieved on the next morning without any neurological deficit. Tracheostome was closed on 8th POD under general anaesthesia and the patient was discharged with excellent cure of her symptoms and kept on regular follow-up in ENT OPD. [ABSTRACT FROM AUTHOR]