Aims To describe a case of subglottic plasmacytoma presenting as acute airway obstruction requiring awake tracheostomy and explore current literature of similar presentations and their management. Methodology A non-systematic literature review was conducted including the terms acute airway, airway obstruction, tracheostomy, plasmacytoma, and/or multiple myeloma. Papers were screened for relevance, as were reference lists of key papers. Results Subglottic plasmacytoma requiring awake tracheostomy for acute airway obstruction has been described only once before in the English literature.(1) Laryngeal plasmacytomas (including both solitary extramedullary plasmacytoma and plasma cell myeloma with laryngeal involvement) are rare with fewer than 200 recorded cases. The subglottis is the least common subsite for laryngeal involvement. Two further case reports were identified describing acute airway obstruction secondary to subglottic plasmacytoma, the first managed with rigid bronchoscopic resection, and the second managed with endotracheal intubation and subsequent tracheostomy under general anaesthetic.(2) Conclusion This case represents an advanced presentation of an extremely rare disease entity requiring emergent awake tracheostomy. Where possible, attention must be given to relevant background history when evaluating new head and neck malignancies with adequate tissue sampling following airway securement. References 1.Jizzini MN, Shah M, Yeung SJ. Extramedullary Plasmacytoma Involving the Trachea: A Case Report and Literature Review. J Emerg Med. 2019;57(3):e65-e67. 2.T, Jalil BA. Extramedullary Plasmacytoma Presenting With Acute Airway Compromise, Treated With Emergent Rigid Bronchoscopic Resection. Journal of Bronchology & Interventional Pulmonology. 2016; 23 (2): e18-e20.