Accidental fire can occur with upper airway injury and can be fatal if inappropriately managed. Effective communication between the anesthetic and the surgical teams can reduce the risk of such an adverse event. Understanding the interaction between fuel, oxidizer, and ignition source in an airway fire may also reduce the incidence. The literature on upper airway thermal injury has focused on prevention and intraoperative management, but few studies have described postburn management. In this report, we describe the intraoperative occurrence of an airway fire during a surgical tracheostomy and subsequent patient management.