Between 1952 and 1982, 55 patients underwent bilateral radical neck dissections at the National Cancer Institute. Of these, 17 patients had simultaneous (one-stage) bilateral dissections and 38 had nonsimultaneous (two-stage) dissections. In 37 patients both internal jugular veins were removed, while one vein was preserved in 18 patients. The operative mortality was 11.8% (2/17 patients) for simultaneous bilateral neck dissections and 2.6% (1/38 patients) for nonsimultaneous staged dissections. The overall operative mortality was 5.4%. Of the 18 patients in whom one jugular vein was preserved, six patients (33%) had postoperative facial edema and swelling, while of the 37 patients in which neither jugular vein was saved, 20 patients (54%) developed significant postoperative facial edema. The overall 2-year recurrence rate was 50%. The overall survival rates were 55% at 3 years and 39% at 5 years.