The most feared postoperative complication of the head and neck surgery is the carotid blowout or spontaneous rupture. The incidence varies from 1 to 5%. A mortality rate as high as 80% and neurological sequelae in 50% among the survivors have been reported. It is recognized that prior radiation therapy enhanced the risk of wound breakdown and carotid rupture. Other influencing factors are the relation of skin incision to the carotid artery, the thickness of skin flaps and the integrity of the carotid adventitia. Tissue coverage of the carotid artery has been advocated as the method of protection likely to prevent carotid rupture. Recently, the authors have been experienced 2 cases of carotid artery rupture who had undergone total laryngectomy with radical neck dissection for laryngeal and hypopharyngeal cancer.