Tracheostomy is a common life-saving surgical procedure, which has its own short- and long-term surgical complications. Occasionally, after being in place for several years, the tube may fracture, causing a foreign body reaction in the bronchus followed by life-threatening pneumonia. We report a rare case of a 29-year-old man with a known leukodystrophy disorder whose tracheostomy tube was never changed in 14 years. He presented with signs of sepsis and respiratory distress. The management and intraoperative findings, including recommendations for tracheostomy care, were described.