Although open tracheostomy is considered a relatively safe procedure in otorhinolaryngology, it is not without complications. One of the rare complications of tracheostomy is retropharyngeal emphysema. A 53-year-old woman with bilateral vocal cord palsy underwent emergent open tracheostomy and postoperatively developed violent coughing, tight jaw during chewing, mild neck pain as well as an abnormal sensation of “small bubbles popping underneath her skin.” Careful palpation of the neck revealed crepitus, and lateral cervical radiograph showed extensive subcutaneous emphysema and retropharyngeal air column. A combination of vigorous cough and tight peristomal sutures of the tracheostomy wound was believed to have caused this complication. Conservative management by peristomal suture removal led to near resolution within two weeks.