In maxillofacial surgery endotracheal tube provides patent airway and prevents patient from aspirating the blood. But serious complications such as tube obstruction or injury have been reported. In this case, endotracheal tube injury by surgical saw during Lefort I osteotomy occurred. We could not exchange the defective tube for a good one using laryngoscope or fiberoptic bronchoscope due to edema and blood in nostril and oral cavity. We didn't have any tube exchanger available too. Therefore, to provide patent and safe airway, we packed gauze around the lacerated part of tube, provided positive end expiratory pressure ventilation and increased oxygen flow. After anesthesia, the damaged tube was safely removed and there were no respiratory complications.