Acute upper airway obstruction following 'staged' bilateral radical neck dissections in previously irradiated patients.

Synchronous bilateral radical neck dissection is generally avoided because of the dramatic oedema that usually ensues. One recommended safer alternative is to perform 'staged' operations. Two case are presented in which acute supraglottic obstruction followed the second neck dissection in patients who had also received radiotherapy to the neck. It is believed that the obstruction was due to swelling following lymphatic destruction secondary to the irradiation, rather than by venous congestion. Some recommendations are made for the management of such cases to avoid this complication.