A series of 394 radical neck dissections performed over the 17 year period 1969-1986 is presented. The shortest period of follow-up is two years. Of the major complications reviewed, wound breakdown was associated with T stage, prior radiotherapy and incision used but not with age or N stage. Cervical recurrence was associated with N stage, prior radiotherapy and surgical incision and inversely associated with age. Wound breakdown and recurrence were lowest in parotid primary tumours. Carotid artery rupture occurred in 17 patients (4.3 per cent), was fatal in all cases and was strongly associated with wound breakdown and previous radiotherapy. The importance of the choice of incision, clearance of the posterior belly of the digastric muscle and carotid artery protection are discussed.