Objective: Adjust Fit ® (AF) is adjusted the own length in the trachea by setting the position of the adjuster. AF is made of a silicon spiral tube, which enables it to transform smoothly into the trachea. However, since only few studies have reported indications and complications of AF, they are unclear. Patients: We retrospectively examined the indications and complications of AF in our 13 patients with AF. Results: The patients were diagnosed as follows: thick subcutaneous tissue on tracheal anterior wall, 9 patients; tracheal deformation and deviation, 3 patients; endotracheal constriction, 1 patient; and unknown, 1 patient (1 patient had two diagnoses). Complications were as follows: tube decannulations, 4 patients; constrictions of tracheostomy tube, 2 patients; and ventilatory failure due to impingement at tracheal wall, 1 patient. AF may be useful in patients with high obesity or deviated trachea after laryngectomy. Cervical computed tomography scan is effective for their indications. However, serious complications, such as tube decannulations or constrictions, exist due to the original structure of AF. Conclusion: AF is a useful device for airway management if we understand its characteristics and use it correctly.