We report a case of massive tongue engorgement associated with placement of an esophageal-tracheal twin-lumen airway device (Combitube) in a morbidly obese patient. Approximately 4 hours after atraumatic placement of the Combitube, tongue swelling occurred. An emergency tracheostomy was needed for airway management before removal of the Combitube. Ischemia-reperfusion injury or compression of glossal blood vessels, specifically lingual veins, was the most likely cause for the patient's tongue engorgement. An exhaustive search for other causes revealed nothing. Prolonged use of the Combitube may incur greater risk of airway complications such as tongue engorgement.