The objective of this presentation is to outline long-term complications and their management in contrast to acute measures after endotracheal laser-induced fire. This case focuses on a 56-year-old patient in whom an endotracheal fire occurred during CO2 laser surgery. Despite local swelling and evidence of acute lung injury, the patient was extubated the following day under single-shot cortisone and inhalation of dispersed adrenaline under assisted spontaneous breathing. Wound healing was assessed by regular flexible bronchoscopy and spirometry. Fourteen weeks after uneventful recovery, the patient presented with acute inspiratory stridor, related to a tracheal stenosis 2.5 cm distal to the glottic level. After tracheal end-to-end anastomosis, further follow-up was uneventful. Early extubation under ITU conditions avoided the need for tracheostomy and its sequelae. However, tracheal stenosis did not become apparent before week 14. While in acute management of laser-induced endotracheal fire a conservative approach was established successfully, the risk of further long-term complications implies the need for a prolonged follow-up regime even in cases of less extensive burns.