To study the surgical management of fatal hemorrhage following head and neck surgery for cancer. The clinical data of 32 cases of fatal hemorrhage following head and neck surgery from 1976 to 2008 in our department were analyzed retrospectively. Hemorrhage was caused by carotid blowout in 20 cases. The carotid ligation was performed in 13 cases, only 6 cases got long-term survival. In 12 cases, hemorrhage was caused by tracheo-innominate artery fistula, only 2 cases received surgical management, and no long-term survivors. Fatal hemorrhage following head and neck surgery is an uncommon but frequently fatal complication, and the successful management of it depends on early diagnosis and correct treatment.