The OFTP is a rare and poorly understood, potentially fatal complication associate with the endotracheal intubation. Neither the real incidence nor the common definition of this complication is known. Sigrist and colleagues first reported a description of an OFTP in 1981 (1); the lemma OFTP was proposed by Deslee (2). A review by Lins and Dobbeleir (3) include, until April 2010, 23 adult cases. The OFTP is usually located at the site of the cuff where are removed by bronchoscopy. Clinical presentation evidence a stridor occurred shortly after extubation due to partial detachment of proximal part of pseudo-membrane producing intermittent respiratory failure caused by a valvelike tracheal obstruction. The spontaneous emission of OFTP has been described only once previously (4). The mechanism of development of pseudo-membranous material is nowadays not completely known. Several risk factors have been proposed as tracheal injury after intubation (5,6), illness (7), infections, caustic lesions of gastric reflux (8), hyper-pressure of endotracheal cuff, wrongly use of large tracheal tubes, length of intubation period. Since the patient described hereby had a difficult intubation inside his car on the trauma scene, the previous evidences described in literature suggest that a traumatic and a forceful intubation may have damaged the tracheal mucosa, triggering the OFTP formation. The tip’s tube shearing on the tracheal mucosa due to an excessive head hyperextension, the repeated micromovements of the tube due to transport and the swallow might have sustained the development of the pseudo-membrane. The chest CT-scan performed 3 hours after the intubation, showed the contact of the tip’s tube (last 3 cm) to the anterior tracheal wall just below the cuff (about 8 cm from cricoid cartilage), and the existence of a luminal tighten close to the posterior tracheal wall and the surface of the tube (Figure 3). It bordered about one third of the posterior tracheal wall. We became aware of this tighten only after the OFTP expulsion when we re-evaluated the CT-scan images: The luminal lesion was the first step of pseudo-membrane developing. The characteristics of OFTP and the histological findings (superficial scratch of the mucosa, thick fibrinous material with polymorphonuclear infiltration and desquamated necrotic tracheal epithelium) were similar to others report in literature and suggest that OFTP represents an early stage of tracheal ischemic damage. As in other reports, the presence of OFTP can be silent, if the membrane adheres to tracheal wall. Consequently, our patient remained asymptomatic for 4 days after extubation; cough reflex caused by nose-gastric tube insertion developed the respiratory distress. We speculated that the patient might have tolerated the OFTP since the analgo-sedation with morphine concurred to diminish trachea-coughing reflex. The pseudo-membrane was spontaneously expectorated few minutes after detach and this is the second report in literature.