Laryngeal mask airways (LMAs) have several advantages compared with conventional endotracheal tube (ETT) in tracheal surgery. LMAs cannot penetrate the airway below the level of the glottis, but enable the access to the larynx and tracheobronchial tree while avoiding airflow impairment, tracheal stimulation, trauma, and the interference of tracheal mucosal blood flow. Moreover, LMAs have lower airway resistance than ETTs. We describe the use of a proseal laryngeal mask airway (PLMA) in patients with high grade upper tracheal stenosis. We suggest that PLMA might have advantages over the classic LMA by preventing aspiration and by allowing the evacuation of air from the stomach in high-grade upper tracheal stenosis.