<p>Management of laryngotracheal stenosis with tracheoesophageal fistula is the most challenging and difficult problem to address surgically. Situation is made worse if the patient has undergone repeated failed attempts for the correction of the stensois. We discuss the surgical management of an 18 year old male with history of trauma neck with prolonged ventilation and tracheostomy. Decannulation failed as it resulted in stridor associated with persistent cough on swallowing and discharge of the secretions mixed with food particles through the tracheostomy. He had undergone multiple surgeries with utilization of the chonchal cartilage and costal cartilage graft for expansion of the subglottic airway. All the previous surgery failed in restoration of the airway with extrusion of the cartilage grafts. On fibreoptic laryngeal examination, a large trachesotoma with a tracheoesophageal fistula just below the inferior border of the posterior lamina of the cricoid cartilage was noticed. Rigid laryngoscopy revealed bilateral fixed vocal cords. He underwent thyrotracheal anastomosis with closure of the tracheoesphageal fistula and interposition of the sternothyroid muscle between the tracheal and esophageal openings of the fistula. We also performed right CO2 laser arytenoidectomy for optimal glottic airway. After 3 weeks of initial surgery, ryles tube was removed as he was swallowing without aspiration and after 6 weeks decannulation was done that is tracheostomy tube was removed. In such complex laryngotracheal defects, approach should be individualized after thorough assessment of the particular case.</p>