Decannulation following tracheostomy is an important transition. Subcutaneous emphysema (SE) following decannulation has been rarely reported. We, herein, report a case of massive subcutaneous emphysema following decannulation of a short-term tracheostomy, discuss the various decannulation methods and causes of SE. We report and hypothesize the tight occlusive dressing method for tracheostomy decannulation to be the possible cause of SE in the present case.